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DONOR AFEREZI

Kanin bir komponetinin alinip, geri kalaninin hastaya veya don?re geri verilmesi islemidir. Sitaferez, kanin h?cresel elemanlarinin ayrilip, geri kalaninin hastaya veya don?re geri verilme islemidir.Plazmaferez, plazmanin ayristirma islemidir.. AFEREZ. . AFEREZ TEKNIKLERI. I. MANUEL Y?NTEMTam kanPlazmaferezII. OTOMATIK Y?NTEMLER1. Sentrifugasyona) Devamli akim b) Intermitan (aralikli akim) 2. Filtrasyon3. Adsorbsiyon.

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DONOR AFEREZI

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    1. DONOR AFEREZI

    2. Kanin bir komponetinin alinip, geri kalaninin hastaya veya donre geri verilmesi islemidir. Sitaferez, kanin hcresel elemanlarinin ayrilip, geri kalaninin hastaya veya donre geri verilme islemidir. Plazmaferez, plazmanin ayristirma islemidir.

    3. AFEREZ TEKNIKLERI I. MANUEL YNTEM Tam kan Plazmaferez II. OTOMATIK YNTEMLER 1. Sentrifugasyon a) Devamli akim b) Intermitan (aralikli akim) 2. Filtrasyon 3. Adsorbsiyon

    4. Aferez prensip Tam Kan (ven)

    5. SANTRIFJ TEKNIGI Santrifj tekniginde hcreler birbirlerinden zgl agirliklarina gre ayrilirlar:En iten disa dogru: Plazma Trombositler Mononkleer hcreler Granlositler Eritrositler seklinde siralanir Bu yntem zellikle sitaferez islemleri iin uygundur.

    6. Aferez metot Santrifj yntemi ile hcreler dansite gradientine gre periferik kandan elde edilir Eritrositler daha yogundur ve dibe gider MNHler daha az yogundur ve ortada bulunur (PLTlerin tam altindadir)

    7. zgl agirlik Plazma 1.025-1.029 Platelet 1.040 Lenfosit 1.070 MNH-Kk Hcre Granulosit 1.087-1.092 Eritrosit 1.093-1.096

    8. FILTRASYON TEKNIGI Filtrasyon tekniginde delikli bir membrandan geirilen hcreler ve plazma, membrandaki porlarin aplarina gre birbirlerinden ayrilirlar. Kan komponentleri birbirlerinden byklklerine (boyutlarina) gre ayrilirlar.

    9. ADSORBSIYON TEKNIGI Daha ok immnoadsorbsiyon islemleri iin kullanilan bir uygulamadir. Bioaktif membranlar kullanilarak istenilen elamanlar plazmadan ayrilir.

    10. 1. Sitaferez a) Lkaferez - Periferik kk hcre aferezi - Lenfositaferez - Granlositaferez b) Trombositaferez c) Eritrositaferez d) Fotoferez 2. Plazmaferez Plazma degisimi Plazma filtrasyonu 3. LDL aferezi

    11. I. Teraptik Aferez (hastaya tedavi amali) Sitaferez Komponent degisimi Plazma immnomodlatr tedavi II. Donr aferezi (Saglikli vericiden kan komponenti toplanmasi) Plazmaferez Trombositaferez Granlositaferez III. Periferik kk hcre aferezi Otolog Allojeneik

    12. Total kan hacmi hesaplamasi (TKH) Gilcherin 5ler kurali

    13. Aferez islemlerinde kullanilan hacim hesaplamalari Total plazma hacmi (TPH)= (1-Htc) X TKH Total eritrosit hacmi (TEH)= Htc X TKH Islem sirasindaki Htc= (TEH-ekstrakorporeal EH) / TKH X100 en az %25 olmalidir.

    14. Kan ve Komponentlerinin Hacimleri (70 kglik bir sahista ortalama...) Total kan volm = 5000 ml Total eritrosit volm = 2250 ml Total plazma volm = 2750 ml Total lokosit volm = 10 ml Total trombosit volm = 7 ml

    15. Antikoagulasyon ACD (9:1 14:1) Bu oran sunlara gre ayarlanir KCFT Platelet sayisi Replasman sivilarina gre Heparin 0.5 2.0 u/ml

    16. Kim aferez vericisi olabilir? Yas: 17. 71. yas (dzenli donor) 17. 61. yas (ilk kez donor) Vucut agirligi: En az 50 kg Hemoglobin/Htk: =12.5 gr/dL and = 38% Donasyon sikligi: RBC iin 56 gn Saglik durumu: Saglikli grnmde ve kendini iyi hissediyor. Tarama: Donasyon zamaninda bir ok sorudan olusan donor degerlendirmesini gemek zorunda: Eger donor Donor beklemek zorunda Dis muayenesi olmussa: Viziteden 3 gn sonra Nezle, grip veya bogaz agrisi: tam iyilesecek Kulak deldirme/ vcut dvme : 6 ay

    17. Iki islem arasindaki sre 48 saatden az olmamak kaydiyla haftada 2 ve yilda 24den fazla verici olmamalidirlar. Aspirin kullanan donrlerden 3 gn sre ile trombosit alinmaz. Donr trombosit sayimi en az 150.000/mm3 olmalidir.

    18. Donasyon Sikligi Tam kan veya aferez RBC: 56 gn ift doz aferez RBC: 112 gn Platelet: 2 gn, haftada 2yi ve yilda 24 kez gememeli Plazma: 28 gn Erkekler yilda 4, kadinlar 3 kez Tam Kan verebilir

    21. Tarama testleri; ABO, Rh tayini, alloantikorlar Transfzyonla geen hastaliklarla ilgili testler yapilmalidir HBsAg, anti-HBc-IgM, Anti-HCV, anti-HIV, sifilis. Tek bir verici iin testlerin 30 gnlk araliklarla tekrarlanmasi nerilmektedir. Gzle grlr eritrosit kontaminasyonu varsa Htc tayini yapilmalidir. Eger 2 mlden fazla eritrosit ieriyorsa uygunluk testleri yapilmalidir.

    22. Donr Trombosit Aferezi: Nasil, hangi cihazla yapmaliyim? Sayin baskanlar, degerli meslektaslarim, degerli aferez alisanlari Sizlere donor trombositaferezinden bahsedecegim Good afternoon, ladies and gentlemen. Today, I am gonna talk about donor Trombosit apheresis.Sayin baskanlar, degerli meslektaslarim, degerli aferez alisanlari Sizlere donor trombositaferezinden bahsedecegim Good afternoon, ladies and gentlemen. Today, I am gonna talk about donor Trombosit apheresis.

    23. Trombositler ne is yapar? Trombositler nasil elde edilir? Trombositlerin asil fonksiyonu : Kanamayi durdurmak ve/veya nlemek Trombosit toplarken iki farkli metot kullanilir: Tek verici trombositleri (SDP= single donor PLT) Otomatik toplama (aferez) yntemiyle elde edilir Rastgele vericiden alinan trombositler (RDP= random donor PLT) Gnll tam kan bagislarindan elde edilir What are Trombosits? How do we collect Trombosits? The primary role of Trombosits is to prevent/control/stop bleeding. There are two different ways to obtain Trombosit concentrate: one is single donor Trombosits (SDPs) which are obtained by automated collection methods. another is random donor Trombosits (RDPs) which are extracted from a community volunteer whole blood donation. What are Trombosits? How do we collect Trombosits? The primary role of Trombosits is to prevent/control/stop bleeding. There are two different ways to obtain Trombosit concentrate: one is single donor Trombosits (SDPs) which are obtained by automated collection methods. another is random donor Trombosits (RDPs) which are extracted from a community volunteer whole blood donation.

    24. Aferez sistemleri ile hazirlanmis trombosit konsantraleri tek bir donrden elde edilir. Buna single donr trombosit konsantresi veya aferez trombosit konsantresi denir.

    25. AFEREZ TROMBOSITI : Kimlerden Hazirlanir ? Rastgele trombosit aferezi= Toplumdaki vericilerden hazirlanir Aile yesinden trombosit aferezi= Hastalarin biyolojik aile yelerinden hazirlanir RDP ne yetersiz yanit veren hastalar iin kullanilir HLA uyumlu trombosit aferezi= HLA uyumlu vericilerden hazirlanir 4/4 yada antijen uyumu tercih edilir Sadece trombosit refrakterliginde kullanilir Apheresis Trombosit Preparations: Apheresis Trombosits are obtained from single donors. 1) Random apheresis Trombosits (RAP's) are collected from community donors. 2) Family donor matched Trombosits are collected from a patient's biologic family member. They are used primarily for patients with poor response to RDPs. 3) HLA matched Trombosits are collected from a donor with whom a recipients HLA type has been matched. The more desirable matches are 4 in 4 or 3 in 4 antigens. They are considered only for patients who are refractory to RDPs.Apheresis Trombosit Preparations: Apheresis Trombosits are obtained from single donors. 1) Random apheresis Trombosits (RAP's) are collected from community donors. 2) Family donor matched Trombosits are collected from a patient's biologic family member. They are used primarily for patients with poor response to RDPs. 3) HLA matched Trombosits are collected from a donor with whom a recipients HLA type has been matched. The more desirable matches are 4 in 4 or 3 in 4 antigens. They are considered only for patients who are refractory to RDPs.

    27. Aferez Trombositi: Niin tercih edilir? Alloimmunizasyonu nlemek iin= rnek: kk hcre nakli alicilari Trombosit refrakter hastalarin tedavisi iin= HLA/Trombosit spesifik antikorlari bulunan hastalar HLA/Trombosit antijen uygun PLT Ynlendirilmis bagis iin: rnek: neonatal trombositopeni Anneden bebege PLT Why are Trombositpheresis Products Requested? They are requested To prevent alloimmunization (e.g., bone marrow transplantation). For refractory patients, HLA/Trombosit antigen matched Trombosit are used for patients with specific HLA/Trombosit antibodies. 3) For directed donations, e.g., mother to baby for neonatal thrombocytopenia (NTP).Why are Trombositpheresis Products Requested? They are requested To prevent alloimmunization (e.g., bone marrow transplantation). For refractory patients, HLA/Trombosit antigen matched Trombosit are used for patients with specific HLA/Trombosit antibodies. 3) For directed donations, e.g., mother to baby for neonatal thrombocytopenia (NTP).

    28. Donr Trombositaferezi: Cihazlar Devamli akim santrifuj Baxter/Fenwal (CS-3000 Plus, Amicus) Gambro/Cobe (Spectra, Trima ) Fresenius (AS104, AS204, Com.Tec) Aralikli akim santrifuj Haemonetics (LN-8150 MCS, LN-9000 MCS, MCS Plus, PCS-2) When we look at the equipment and Technique Current apheresis instruments use continuous flow centrifugation systems like COBEinstruments (Spectra, Trima), Baxter/ Fenwal (CS3000 Plus, Amicus), Fresenius (AS104, AS204, Com.Tec), or intermittent flow centrifugation systems Haemonetics equipments (MCS/MCS Plus, PCS-2) When we look at the equipment and Technique Current apheresis instruments use continuous flow centrifugation systems like COBEinstruments (Spectra, Trima), Baxter/ Fenwal (CS3000 Plus, Amicus), Fresenius (AS104, AS204, Com.Tec), or intermittent flow centrifugation systems Haemonetics equipments (MCS/MCS Plus, PCS-2)

    30. Aferez trombosit avantajlari Ekonomik kan rn kullanimi Nispeten daha fazla miktarda seilmis rn toplama Daha sik donasyon olasiligi Laboratuarda diger kan rnleri ayirimina gereksinim olmamasi ok fazla sayida donore maruziyetinin nlenmesi Hastalik bulasma riskinde azalma HLA alloimmnizasyon riskinde azalma Daha nce alloimmnize olmus hastalarda etkili tedavi Lkosit azaltilmasi Ilave filtrasyon islemine gerek olmamasi Depolama ncesi lkosit azaltilmasi Tekrarlayan FNHTR nlemesi Filtrasyon basarisizligini nlemesi Filtrasyonla olabilen hcre kaybini nlemesi

    31. Aferez trombosit sspansiyonlari 1) HLA immnizasyonu nedeniyle random donr trombosit sspansiyonlarina yanitsiz olan hastalarda HLA veya cross-match uygun aferez trombosit sspansiyonlari nerilmektedir. 2) Yogun trombosit transfzyonuna gereksinim duyulan hasta gruplarinda Fazla sayida donre maruziyeti nlemek iin Transfzyon ile bulasan hastaliklardan korumak iin yaygin olarak HLA uygun olmayan aferez trombosit sspansiyonlari kullanilmaktadir.

    32. Aferez trombosit ENDIKASYONU 1) HLA immnizasyonu nedeniyle random donr trombosit sspansiyonlarina yanitsiz olan hastalarda HLA veya cross-match uygun aferez trombosit sspansiyonlari nerilmektedir. 2) Yogun trombosit transfzyonuna gereksinim duyulan hasta gruplarinda Fazla sayida donre maruziyeti nlemek iin Transfzyon ile bulasan hastaliklardan korumak iin yaygin olarak HLA uygun olmayan aferez trombosit sspansiyonlari kullanilmaktadir.

    33. Aferez vs. Random trombosit sspansiyonlari Alloimmnizasyon sikligi Uzun dnem trombosit destegi gereken hastalarda transfzyon sikligi Etkinlik Bakimindan anlamli farklilik gstermemektedir.

    34. Aferez trombositi: zellikler If we look at characteristics of Donor Trombositapheresis Product: 1) They are available in one or more different sizes. 2) Each unit must contain at least 3x10e11 Trombosits in 200-700 mL (90%) according to AABB. 3)Leukocyte must be less than <5 x10e6 according to USA standards and <1x10e6 according to european standards. 4) pH must be 6.8-7.4 ( at least more than > 6.2 at 5 days) (90%) 5) They are stored at temperature between +20-24?C for 5 days and agitated continuously in appropriate equipment during storage 6)They are stored for 5 days. However, some studies report that if product culture is negative on days 1-3, shelf-life of products can be extended to 7 days. SDPs must be stored in plastic bags which must be gas permeable to ensure oxygen availability for Trombosits. Trombosit survival time is normal when Trombosits are stored at 22?C or above but is reduced after storage at lower temperatures. The storage duration is primarily determined by relatively high risk of bacterial growth at room temperature. Currently, IN USA, Trombosit storage is limited to 5 days due to the potential bacterial growth over time. Some studies (European) reported that if the culture of Trombosit product is negative on 1-3 days of storage, culture-negative Trombosits shelf life can be extended to 7 days. So, the number of outdates is reduced.If we look at characteristics of Donor Trombositapheresis Product: 1) They are available in one or more different sizes. 2) Each unit must contain at least 3x10e11 Trombosits in 200-700 mL (90%) according to AABB. 3)Leukocyte must be less than <5 x10e6 according to USA standards and <1x10e6 according to european standards. 4) pH must be 6.8-7.4 ( at least more than > 6.2 at 5 days) (90%) 5) They are stored at temperature between +20-24?C for 5 days and agitated continuously in appropriate equipment during storage 6)They are stored for 5 days. However, some studies report that if product culture is negative on days 1-3, shelf-life of products can be extended to 7 days. SDPs must be stored in plastic bags which must be gas permeable to ensure oxygen availability for Trombosits. Trombosit survival time is normal when Trombosits are stored at 22?C or above but is reduced after storage at lower temperatures. The storage duration is primarily determined by relatively high risk of bacterial growth at room temperature. Currently, IN USA, Trombosit storage is limited to 5 days due to the potential bacterial growth over time. Some studies (European) reported that if the culture of Trombosit product is negative on 1-3 days of storage, culture-negative Trombosits shelf life can be extended to 7 days. So, the number of outdates is reduced.

    35. rn pH depolama sresince 6.8 - 7.4 arasinda olmalidir Trombositlerin yeterli miktarda plazma ile sspanse edildigini ve uygun isida saklandigini gsterir pH degeri = 6 (FDA) pH degeri = 6.2 (AABB) pH degeri =6.8 (Avrupa) pH i etkileyen en nemli faktr : rn hacmi ve trombosit sayisidir PLT fazla ve plazma az ise pH ? pH ?= PLT sekil degisikligi ve canliligi ? Donor trombositaferezi rn: pH When we look at the pH: During storage product pH must remain between 6.8 - 7.4. Lets look at the pH requirements at the end of the storage period. FDA requires no less than 6.0 AABB requires more than 6.2 Europe requires more than 6.8 As a result, component volume and the number of Trombosits in the component are the most important measures affecting Trombosit product pH. (pH may decrease during storage of Trombosit components with a high Trombosit concentraion pH is an indicator to demonstrate Trombosits are resuspended in adequate amount of plasma and stored at an optimal temperature. pH of Trombosit components decreases during storage owing to cell metabolism. When oxygen availability is limited, glycolysis ensues and lactic acid production increases. Therefore, the increased production of lactic acid in the course of glycolysis result in (lead to=cause) a decrease in pH. Trombosits naturally exist in an environment with a pH value of 7.4. If sufficient oxygen is not available, pH decreases. As the pH decreases to between 6.8 and 6.2, Trombosits gradually lose their discoid appearance and become spherical. This transformation is reversible with no loss of viability, but pH decreases to 6.0 and below an irreversible transformation takes place. The resulting Trombosits are not suitable for transfusion.) When we look at the pH: During storage product pH must remain between 6.8 - 7.4. Lets look at the pH requirements at the end of the storage period. FDA requires no less than 6.0 AABB requires more than 6.2 Europe requires more than 6.8 As a result, component volume and the number of Trombosits in the component are the most important measures affecting Trombosit product pH. (pH may decrease during storage of Trombosit components with a high Trombosit concentraion pH is an indicator to demonstrate Trombosits are resuspended in adequate amount of plasma and stored at an optimal temperature. pH of Trombosit components decreases during storage owing to cell metabolism. When oxygen availability is limited, glycolysis ensues and lactic acid production increases. Therefore, the increased production of lactic acid in the course of glycolysis result in (lead to=cause) a decrease in pH. Trombosits naturally exist in an environment with a pH value of 7.4. If sufficient oxygen is not available, pH decreases. As the pH decreases to between 6.8 and 6.2, Trombosits gradually lose their discoid appearance and become spherical. This transformation is reversible with no loss of viability, but pH decreases to 6.0 and below an irreversible transformation takes place. The resulting Trombosits are not suitable for transfusion.)

    36. Aferez platelet : Bakteriyel Tespit ~1/1000 PLT unit bakteri ierir Yilda ~100 PLT alicisi kontaminasyon nedeniyle lr Bakteri tespit yntemleri : Grsel PLT Swirling inspeksiyonu Spesifisite olduka dsk, sensitivite % 50-75 Mikroskopik inceleme Spesifisite > %99.0, sensitivite % 80-100 pH ve glukoz lm Bakteriyel Kltr Iki ticari sistem var CO2 olusumunu tespit eder (BioMerieux BacT/ALERT) O2 tketimini tespit eder (Pall BDS) Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    37. Aferez platelet : Bakteriyel Tespit 1) Grsel PLT Swirling inspeksiyonu PLT morfolojisi PLT canliligini gsterir Diskoid PLTler; viabilitesi daha iyidir Swirling dsk Phda bakteriyel metabolizma sonucu azalir PLTler 10e7-10e8 CFU/mL bakteri varliginda swirl kaybederler. Ancak, 5 gnlkten daha fazla PLTler swirl olmadigi bildirilmektedir. Bu yzden bakteri tespiti iin bu yaklasimin spesifitesi olduka dsktr Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    38. Aferez platelet : Bakteriyel Tespit Bakteriyel reme pH dssne neden olur ve bunun sonucu olarak PLTler diskoid yapiyi kaybederler; Grsel inspeksiyon (swirling iin) bakteriyel kontaminasyonu tespiti iin yaklasik %50-75 sensitiviteye sahiptir. Fakat bu yaklasim pHin en az 6.2 oldugunu gsterir Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    39. Aferez platelet : Bakteriyel Tespit 2) Mikroskopik inceleme: Gram boyasi boyanmis rneklerin mikroskopik incelemesi pahali olmayan bir yntemdir. Nisbeten duyarsiz (zellikle taze komponentte) 1-5 gnlk gnlk PLTler yapilan bir alismada %80 sensitivite ve %99.96 spesifisite bildirilmistir 4-5 gnlk PLTler, sensitivite %100, spesifisite ise %99.3 bildirilmistir Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    40. Aferez platelet : Bakteriyel Tespit 3) pH ve glukoz lm: Bakteri nedeniyle Phda dss ve glukoz tketimi bakteriyel kontaminasyon iin kullanilmaktadir. Fakat esik degerleri hakkinda konsensus yoktur Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    41. Aferez platelet : Bakteriyel Tespit 4) Bakteriyel Kltr: Bakteriyel agalmayi tespit etmek iin gelistirilmis mevcut 2 ticari sistem vardir Bu sistemlerden biri bakterilerin CO2 olusumuna dayanarak bakteriyel remeyi gsterir Digeri ise bakterilerin O2 tketimine dayanarak bakteriyel remeyi gsterir Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).Bacterial Detection of platelet Products: Approximately 1 in 1,000 platelet units contains bacteria (baktiriya), and nearly 100 platelet recipients die from receiving contaminated units per year in the US. There are several methods to detect bacterial contamination. 1) Visual inspection for PLT Swirling: The morphology of PLTs is predictive of their viability. Discoid PLTs, which have better viability. Swirling is diminished at a lower pH, which can be a consequence of bacterial metabolism. PLTs loose theirswirl at 10e7-10e8 CFU/mL bacteria levels (Wagner SJ Transfusion 1996). However, up to 20% of 5-day-old PLTs have been reported not to swirl, so the specificity of this approach to detection of bacteria is quite low (Bertolini F Transfusion 1994) Bacterial growth can cause a drop in pH and, as a result, platelets lost of the discoid form; Visual inspection (for maintenance of swirling) has a sensitivity of approximately 50-75% for detecting bacterial contamination. But, this approach does offer the additional benefit to verify that the pH is at least 6.2. (;checking for maintenance of swirling has a sensitivity of approximately 50-75% for detecting bacterial contamination but does offer the additional benefit of verifying that the pH is at least 6.2.) 2) Microscopic examination: Microscopic examination of samples treated with Grams stain is an inexpensive method that is relatively insensitive, particularly for fresher components. One study found 80% sensitivity and 99.96% specificity in platelets aged 1-5 days. In 4-5-day old PLTs, the sensitivity improved to 100%, with a specificity of 99.3% (Yomtovian R Transfusion 1993). 3) Measure pH and glucose : The drop in pH and the consumption of glucose due to bacteria can be used for bacterial contamination . But there is no concensus about their treshold level. 4) Bacterial Culture: There are Two commercial systems to detect bacterial growth; one detects the growth of bacteria by their generation of CO2, and the other detects growth by their consumption of O2 (Brecher ME Transfusion 2002, McDonald CP, Vox sang 2002).

    42. Trombosit rnn etkileyen faktrler nelerdir? Islem iin kullanilan makine Islem ncesi trombosit sayisi Islem ncesi Hb seviyesi Toplam kan hacmi Donr vcut agirligi Donr cinsiyeti Islem sresi Lets look at somethings that affects Trombosit yield. Trombosit yield is affected by Apheresis instruments used, Pre (pri)-donation Trombosit count, Pre-donation Hb level, Total blood volume, Donor weight, Donor gender and Procedure duration. There is wide variation in the number of Trombosits obtained from Trombositapheresis donations. Variability may stem (come=spring=result) from differences in apheresis instruments used, in donor Trombosit counts and in collection parameters (20-24).Lets look at somethings that affects Trombosit yield. Trombosit yield is affected by Apheresis instruments used, Pre (pri)-donation Trombosit count, Pre-donation Hb level, Total blood volume, Donor weight, Donor gender and Procedure duration. There is wide variation in the number of Trombosits obtained from Trombositapheresis donations. Variability may stem (come=spring=result) from differences in apheresis instruments used, in donor Trombosit counts and in collection parameters (20-24).

    43. Donor trombositaferez rn belirleyicileri: Oniki Aferez Sistemi On this slide; you can see examples of how different instrument affects Trombosit yield. Depending on the method and instruments used each procedure gave a Trombosit yield from 2.4 to 7.1 x1011 Trombosit.On this slide; you can see examples of how different instrument affects Trombosit yield. Depending on the method and instruments used each procedure gave a Trombosit yield from 2.4 to 7.1 x1011 Trombosit.

    44. Trombosit rn: Yedi makinanin karsilastirilmasi The following chart (Figure, table, slide) shows Comparison of seven instruments in terms of Trombosit yield The highest Trombosit yield which was 5.6 x1011 was obtained by Cobe Spectra V4 and the lowest Trombosit yield which was 3.6 x 1011 was obtained by MCS+ (Trombosit yields varied 3.6-5.6 x 10e11).The following chart (Figure, table, slide) shows Comparison of seven instruments in terms of Trombosit yield The highest Trombosit yield which was 5.6 x1011 was obtained by Cobe Spectra V4 and the lowest Trombosit yield which was 3.6 x 1011 was obtained by MCS+ (Trombosit yields varied 3.6-5.6 x 10e11).

    45. When we look at comparison of instruments with respect to Trombosit Yield in Fixed 90 Minute Duration: Amicus and Spectra Turbo were complied best with the target. When we look at comparison of instruments with respect to Trombosit Yield in Fixed 90 Minute Duration: Amicus and Spectra Turbo were complied best with the target.

    46. Aferez trombosit rn belirleyicileri: Hb seviyesi Donor Hbi trombosit rnnn nceden belirlenmesinde nemlidir Ters iliski vardir Dsk hb dzeyinde daha yksek trombosit rn alinir Dsk hb dzeyi yksek plazma volmyle iliskilidir Now, Lets look at Hb level and Trombosit yield association: Donor Hb is another variable predictive of Trombosit yield but in inverse fashion: lower Hb corresponds to higher Trombosit yield. Perhaps low Hb concentraion is associated with higher plasma volume processed.Now, Lets look at Hb level and Trombosit yield association: Donor Hb is another variable predictive of Trombosit yield but in inverse fashion: lower Hb corresponds to higher Trombosit yield. Perhaps low Hb concentraion is associated with higher plasma volume processed.

    47. Aferez trombosit rn belirleyicileri: Cinsiyet Trombosit rnnde anlamli bir fark yoktur Kadinlarda daha yksek trombosit rnne egilim oldugu grlmstr Yksek trombosit sayisi temelde ; Uzun islem sresi Ileri derece demir yetersizligi Hormonal etkilesim If we look at Trombosit yield and gender association: There is no significant differences in Trombosit yields between female and male. Some studies revealed that Women tend to have higher Trombosit yield. Reason could be high baseline Trombosit count combined with long procedure time, higher prevalence of iron deficiency among women and Hormonal influence. It is possible that hormonal influence also plays a role because an increase has been observed in Trombosit count in mid-menstrual cycle and decrease at the beginning of the cycle (Rivera SG et al. Arc Med Research 2003;34:120-123 and Lasky LC et al. Transfusion 1981;21:719-22, Kalis et al J Clin Apheresis 1987;3:320-234).If we look at Trombosit yield and gender association: There is no significant differences in Trombosit yields between female and male. Some studies revealed that Women tend to have higher Trombosit yield. Reason could be high baseline Trombosit count combined with long procedure time, higher prevalence of iron deficiency among women and Hormonal influence. It is possible that hormonal influence also plays a role because an increase has been observed in Trombosit count in mid-menstrual cycle and decrease at the beginning of the cycle (Rivera SG et al. Arc Med Research 2003;34:120-123 and Lasky LC et al. Transfusion 1981;21:719-22, Kalis et al J Clin Apheresis 1987;3:320-234).

    48. Aferez trombosit rn belirleyicileri: Islem ncesi Trombosit sayisi Elde edilen yksek rnn %si ve trombosit rnnn temel belirleyicisidir Trombosit sayisinin islem ncesi daha fazla olmasi fazla trombosit rn eldesine sebep olur Yksek seviyede trombosit rn dsk trombosit sayilarinda da elde edilebilir When we take a look at Predonation Trombosit count and Trombosit Yield association: Predonation Trombosit count is main predictor of Trombosit yield and % of high-yield product. Higher predonation Trombosit count (>220-270-300 x10e3) results in higher Trombosit yield. However, high Trombosit yield can be obtained even with low preprocedure Trombosit count.When we take a look at Predonation Trombosit count and Trombosit Yield association: Predonation Trombosit count is main predictor of Trombosit yield and % of high-yield product. Higher predonation Trombosit count (>220-270-300 x10e3) results in higher Trombosit yield. However, high Trombosit yield can be obtained even with low preprocedure Trombosit count.

    49. Aferez trombosit rn belirleyicileri: Islem ncesi Trombosit sayisi: Pre- Trombosit sayisi ile Trombosit rn baglantilidir Normal/dsk Trombosit degerli donrlerde islem sresi uzatilarak gvenli kan bagisi saglanabilir Trombosit sayisindaki azalma bagis sikligi ile daha ok iliskilidir You can see in this slide; If you look at the numbers in blue you can see Trombosit yield correlates with pre-donation Trombosit count. If you look at the numbers in red you can see donor with low/normal Trombosit can safely donate satisfactory PCs by extending the procedure time. But, There is a risk of decrease in Trombosit count if a person donate too frequently.You can see in this slide; If you look at the numbers in blue you can see Trombosit yield correlates with pre-donation Trombosit count. If you look at the numbers in red you can see donor with low/normal Trombosit can safely donate satisfactory PCs by extending the procedure time. But, There is a risk of decrease in Trombosit count if a person donate too frequently.

    50. Aferez trombositi: ift veya daha fazla nite Trombosit sayisi yksek olan donrlerde (>250.000/uL) Iki yada niteye karsilik gelen trombosit rn elde edilebilir rn torbasinda = 6.0 x1011 trombosit olmali (ift unite) Her bir nite en az > 3 x 1011 trombosit iermeli Islem sresinde hafif uzama Trombosit kaybinda hafif artis Ciddi olmayan donor komplikasyonlarinda hafif artis Lets look at split apheresis Trombosits: Donors with high Trombosit counts are able to donate double or triple doses Trombosit during one donation. Yield in bag must be more than = 6.0 x1011 Trombosits Each unit must contain at least 3 x 1011 Trombosits But, Procedure time is Slightly longer compared to SU.Lets look at split apheresis Trombosits: Donors with high Trombosit counts are able to donate double or triple doses Trombosit during one donation. Yield in bag must be more than = 6.0 x1011 Trombosits Each unit must contain at least 3 x 1011 Trombosits But, Procedure time is Slightly longer compared to SU.

    51. Hangi cihaz ?: Iki ve daha fazla doz When we look at the studies related to split rates: Split rate varies between 5 and 85% depending on instruments used. Split rate is higher in new generation instruments as shown in this slide.When we look at the studies related to split rates: Split rate varies between 5 and 85% depending on instruments used. Split rate is higher in new generation instruments as shown in this slide.

    52. Hangi cihaz ?: Iki ve daha fazla doz When we take a look at the Split Rate in selected Apheresis Instruments: Trima and Amicus have a higher split rate compared to others.When we take a look at the Split Rate in selected Apheresis Instruments: Trima and Amicus have a higher split rate compared to others.

    53. Hangi cihaz ?: Islem sresi Islem sresinin kisa yada uzun olmasi rn kadar nemlidir Yeni nesil aletlerde islem sresi daha kisadir DN de islem sresi daha kisadir Iki/ rn eldesinde islem sresi daha uzun If we look at procedure time: 2) In todays world, doing more with less time is important as much as yield when evaluating equipment. 3) new generation instruments have lower processing time compared to others. 4) SN would be expected to have longer PT. 5) Processing time plays a major role in determining CR. Processing time is that blood is being processed (did not include reinfusion or final pass return). If we look at procedure time: 2) In todays world, doing more with less time is important as much as yield when evaluating equipment. 3) new generation instruments have lower processing time compared to others. 4) SN would be expected to have longer PT. 5) Processing time plays a major role in determining CR. Processing time is that blood is being processed (did not include reinfusion or final pass return).

    54. Hangi cihaz ?: Islem sresi Aferez Sistemlerinin kiyaslanmasi Procedure time was 64 min for SU and 90 min for DU with Amicus and 77 min for SU and 87 min for DU with Spectra Turbo. So, you can see that we can do more with less time with todays equipments.Procedure time was 64 min for SU and 90 min for DU with Amicus and 77 min for SU and 87 min for DU with Spectra Turbo. So, you can see that we can do more with less time with todays equipments.

    55. Hangi cihaz ?: Toplama yeterliligi (CE) Daha az hacim isleyerek daha fazla rn elde edilmesini ifade eder Toplanan trombosit ile hesaplanan trombositi karsilastirir: Trombosit rn x100/ {(pre+post Trombosit)/2 x (islenen hacim-antikoag hacmi)} Islenen kan volm CE belirlenmesinde nemli rol oynar Fakat ters iliskilidir CEnin belirlenmesine katkida bulunan bir diger faktrde rndeki PLT sayisi Yeni cihazlar daha yksek CEne sahiptir CE compares collected amount of Trombosit with calculated. New generation instruments result in higher CE. Blood volume processed plays major role in CE but inverse fashion. For example Trima have to process significantly more whole blood to obtain Trombosit target, which results in a significantly lower CE (Burgstaler et al Transfusion 2004). Design of the collection chambers is another contributing factor in CE: The single stage channel is more efficient in Trombosit collection. This figure compares CE obtained from four Trombositpheresis systems. Amicus was significantly higher CE than all systems with 73%. CE compares collected amount of Trombosit with calculated. New generation instruments result in higher CE. Blood volume processed plays major role in CE but inverse fashion. For example Trima have to process significantly more whole blood to obtain Trombosit target, which results in a significantly lower CE (Burgstaler et al Transfusion 2004). Design of the collection chambers is another contributing factor in CE: The single stage channel is more efficient in Trombosit collection. This figure compares CE obtained from four Trombositpheresis systems. Amicus was significantly higher CE than all systems with 73%.

    56. Hangi cihaz ?: Toplama yeterliligi (CE) Tek vs. ift giris ile toplanmasi Lets look at CE in single vs double needle collections: CEs vary between 42 and 85%. New generation instruments are more efficient than other systems.Lets look at CE in single vs double needle collections: CEs vary between 42 and 85%. New generation instruments are more efficient than other systems.

    57. Hangi cihaz ?: Toplama Orani (CR) Sistemleri kiyaslamada daha pratik bir yntemdir Es zamanli Trombosit rn ve islem sresi ile elde edilir CR= Trombosit rn / islem sresi CR da islem sresi nemli rol oynar CR is most practical way to compare apheresis systems. CR address Trombosit yield and processing time simultaneously. Processing time plays a major role in determining CR. This table compares CR of 4 systems: Amicus was significantly higher.CR is most practical way to compare apheresis systems. CR address Trombosit yield and processing time simultaneously. Processing time plays a major role in determining CR. This table compares CR of 4 systems: Amicus was significantly higher.

    58. Hangi cihaz ?: Toplama Orani (CR) Sekiz sistemin kiyaslanmasi The following figure shows eight systems comparison in terms of CR: Amicus-SN and DN had a significantly higher CR than all other systems. The following figure shows eight systems comparison in terms of CR: Amicus-SN and DN had a significantly higher CR than all other systems.

    59. Hangi cihaz?: Lokosit azaltilmasi Except for AS104, all other systems met the AABB and European standards.Except for AS104, all other systems met the AABB and European standards.

    60. Aferez ile Lkoredksiyon Yeni kusak makinalar ile Avrupa / US standartlarinda lokosit azaltilmasi yapilabilmektedir: Laboratuar is yk azalabilir rn kalite ve gvenligi artirabilir Depolama ncesi lkosit sayisi azaltilabilir HLA-alloimmunizasyon riski azalabilir Hastalik bulasma riski azalabilir FNHTR nlenebilir Filtre yetersizligi nlenebilir Filtre ile olusabilecek hcre kaybi nlenebilir Toplamda maliyet avantaji saglayabilir Lets take a look at leukoreduction: A) There is no significant differences between new generation machines. New machines complied with European and US leukoreduction guidelines. C) Leukoreduced apheresis products 1) reduce laboratory workload and 2) increase product quality and safety because of Leukoreduction prior to storage Reduce risk of HLA-alloimmunization (aloimyunizeysin) Reduce risk of disease transmission Prevent FNHTR No filter failure No loss of cells in filter 3) It has also Potential cost advantage. Lets take a look at leukoreduction: A) There is no significant differences between new generation machines. New machines complied with European and US leukoreduction guidelines. C) Leukoreduced apheresis products 1) reduce laboratory workload and 2) increase product quality and safety because of Leukoreduction prior to storage Reduce risk of HLA-alloimmunization (aloimyunizeysin) Reduce risk of disease transmission Prevent FNHTR No filter failure No loss of cells in filter 3) It has also Potential cost advantage.

    61. Hangi cihaz?: Islem sonrasi trombosit sayisi Trombosit sayisi %10-35 oraninda azalmakta Yeni nesil sistemler arasinda anlamli fark yoktur Islem sonrasi trombosit sayisi nadiren 90,000 alti Birka gnde eski dzeyine ulasmakta Drt gnde islem ncesi degere geri ykselmekte Kanama komplikasyonu ok nadir 1) There is no detailed data about effects of different apheresis procedures and split units on donor Trombosit counts. 2) In healthy donors,Trombosit count can drop 10-35% but there is No significant differences between new generation apheresis systems. 3) Rarely it can drop below 90.000 4) recovers in several days without bleeding complications. (Return to baseline was seen in 4 days and a rebound increase above the baseline was seen 8 to 11 days after the procedure (Lasky LC et al. Transfusion 1981;21:247-60)). 1) There is no detailed data about effects of different apheresis procedures and split units on donor Trombosit counts. 2) In healthy donors,Trombosit count can drop 10-35% but there is No significant differences between new generation apheresis systems. 3) Rarely it can drop below 90.000 4) recovers in several days without bleeding complications. (Return to baseline was seen in 4 days and a rebound increase above the baseline was seen 8 to 11 days after the procedure (Lasky LC et al. Transfusion 1981;21:247-60)).

    64. Hangi cihaz? Amicus vs Com.Tec Her iki cihaz ile toplanan hedef trombosit yeterli idi Her iki cihaz ile rehberlere uygun lkoreduksiyon yapilabildi Amicusun avantaji, daha hizli hedef trombosit rn saglanmasi idi

    65. Donr Aferezi: Komplikasyonlar Nisbeten sik Sitrat toksitesi Akim hizinin ayarlanmasi yada kalsiyum uygulamasi ile kontrol edilebilir Islem ncesi rutin kalsiyum uygulamasi nerilmez Hematom yada damar yolu komplikasyonlari Nadir Allerji (Sitrat, set vs) Selllit Tromboz Volm durumunda degisiklik Lets take a look at complications: The most common adverse effects are related to citrate useed during the procedures. Fortunately, most citrate related symptoms can be controlled easily by adjusting the machine flow rates or administration of calcium. Authors do not recommend routine administration of oral calcium before apheresis Some authors recommend that donors with a prior history of significant citrate-related symptoms or with high risk of citrate effects (female donors receiving high citrate infusion rates) be given oral calcium 2gr, 30 min before apheresis (Bolon et al 2003) (NIH)Lets take a look at complications: The most common adverse effects are related to citrate useed during the procedures. Fortunately, most citrate related symptoms can be controlled easily by adjusting the machine flow rates or administration of calcium. Authors do not recommend routine administration of oral calcium before apheresis Some authors recommend that donors with a prior history of significant citrate-related symptoms or with high risk of citrate effects (female donors receiving high citrate infusion rates) be given oral calcium 2gr, 30 min before apheresis (Bolon et al 2003) (NIH)

    66. Donre uzun dnem etkileri Hb, Trombosit ve WBC sayisinda anlamli degisiklik izlenmemekte Mutlak lenfosit sayisi azalabilir Immundisfonksiyona yol atigi gsterilememis Demir eksikligi da az siklikla grlebilir Trombositaferez tekrarlamak gvenlidir Uzun dnemde nemli olmayan minimal degisiklik olabilir When we look at Long Term Effects of Trombositpheresis on Donors: There is no significant changes in Hb level, Trombosit count or WBC count Absolute lymphocyte counts can be low in, but there is no evidence of immune dysfunction. Iron deficiency is less frequent 4) Repeated Trombositpheresis is safe, with minimal change of long-term effects.When we look at Long Term Effects of Trombositpheresis on Donors: There is no significant changes in Hb level, Trombosit count or WBC count Absolute lymphocyte counts can be low in, but there is no evidence of immune dysfunction. Iron deficiency is less frequent 4) Repeated Trombositpheresis is safe, with minimal change of long-term effects.

    67. Trombositaferez: Ekonomik Uygulanabilirligi RDP ile maliyet olarak karsilastirilabilir: Gerekesi; Yksek tekrarlama orani Donr maruziyetinin azaltilmasi= Enfeksiyon riskinin azaltilmasi Lkoreduksiyon iin ilave manuplasyonlara gerek olmamasi sayilabilir If we look at Economic Feasibility of SDPs: Although costs for SDP are still significantly higher than for RDPs, additional costs of SDPs may be justified by the high split rates obtained and the reduction in risk of infection due to Reduction of donor exposure 3) leukoreduced Trombosits units obtained (Do not require filtration and this contributes to reduced costs and laboratory workload). If we look at Economic Feasibility of SDPs: Although costs for SDP are still significantly higher than for RDPs, additional costs of SDPs may be justified by the high split rates obtained and the reduction in risk of infection due to Reduction of donor exposure 3) leukoreduced Trombosits units obtained (Do not require filtration and this contributes to reduced costs and laboratory workload).

    68. Sonu Yeni nesil cihazlar yksek performansa sahip: Trombosit rn, toplama kabiliyeti, toplama hizi, ayirma hizi, islem sresi ve donr rahatligi Avrupa/US kilavuzlarina uygun lkosit azaltilmasi Yksek ayirma hizi, enfeksiyon riskinin azaltilmasi, lkoredksiyon, maliyeti nemli lde azaltabilir Trombositferez islemi gvenli Uzun dnem etkilerde minimal degisiklik mevcuttur As a conclusion: Newer machines have the best overall performance: in terms of Trombosit yield, collection efficiency, collection rate, split rate, procedure time and donor comfort They Comply with European / US leukoreduction guidelines Significantly higher costs compared to RDPs may be justified by High split rates, reduced risk of infection, Leukoreduction Repeated Trombositpheresis is safe with minimal change in long-term effects Thank you very much for your attentionAs a conclusion: Newer machines have the best overall performance: in terms of Trombosit yield, collection efficiency, collection rate, split rate, procedure time and donor comfort They Comply with European / US leukoreduction guidelines Significantly higher costs compared to RDPs may be justified by High split rates, reduced risk of infection, Leukoreduction Repeated Trombositpheresis is safe with minimal change in long-term effects Thank you very much for your attention

    70. Eritrosit aferezi

    71. Eritrosit aferezi Aferez ile 2 eritrosit sspansyonuna esit (2-RBC ) eritrosit toplanmasi 1997den beri gereklestirilmektedir Islemin gvenli olduguna dair ok sayida literatr bulunmaktadir. Islem sresi ortalama 30 dakikadir (donr htc ve toplama hizina bagli) Islem hem otolog hem allojenik amali gereklestirilebilmekle beraber ogu allojenik amali yapilmaktadir. Bu islemlerin sayisi her yil % 40 oraninda artmaktadir.

    72. Eritrosit aferezi

    73. ogu kan toplayicinin hedef kitlesi B, O ve Rh negatiflerdir. Post donasyon sonrasi sre 16 haftadir. 16 haftalik post donasyon sresi sonrasi bir yil iinde iki eritrosit sspansiyonu donasyonu kan toplayici veya donrler tarafindan kolayca ynetilebilir bir durumdur. Amerikali donr iin yillik ortalama eritrosit donasyonu sayisi 1.4 dir. Eritrosit aferezi

    74. Bazi uzmanlar eritrosit donrlerinin % 10na 2-RBCA islemi yapilirsa eritrosit ihtiyacinin giderilecegini iddia etmektedirler. Aferez kan toplama iin yksek okul grencilerini hedef olarak grmektedirler. Gen nfusun bu otomatik teknolojiye ilgi duymasi Islemde artmis donr gvenligi. Eritrosit aferezi

    75. Yksek okul grencilerinin %16 da vazovagal reaksiyonlar izlenmektedir. Agirlik ve ilk defa kan donr olmak nemli risk faktrleridir. Aferez orta ve agir vazo vagal reaksiyon sikligini azaltir. % 2-5 sikliginda vazovagal reaksiyon, %0.08-0.34 sikliginda senkop grlmektedir. Izotonik solsyonlarin kullanilmasi veya Uzun aferez islemi sirasinda saglanan sivi dengesi nedeni ile olabilir. Eritrosit toplanmasi islem zerinde daha fazla kontrol imkani verir. Wiltbank KT et al. Transfusion 2002; 42: 678. Popovsky MA. Blood Therapy Med 2002; 2: 1-3 Eritrosit aferezi

    76. Wiltbank ve arkadaslarinin yaptigi bir alismada aferez donrlerinde (2-RBCA veya RBC-plazma) manuel islemlerde orta dereceli reaksiyonlarin grlme sikligi 10.000 hastada %14.5, aferez islemlerinde %6.2 dir. Eritrosit aferezi

    77. Iki eritrosit sspansiyonun bir donrden toplanmasi ile (veya diger komponent kombinasyonlari) kan merkezleri donr yks kan toplanmasi enfeksiyon hastaliklari testleri ve komponent hazirlanmasi ilgili yanlisliklarin olusma sansini azaltir. Daha az donr maruziyeti oldugu gvenli bir rn saglar. Her iki yari rn ayni kisiye transfzyon yapilabilir. Manuel toplanan tam kanin eritrosit hacimleri degiskenlik gsterir. Bu donrlerin hematokriti ve hacimleri arasindaki farktan dolayidir. Eritrosit kitleleri arasindaki fark % 40 a kadar ikabilir. Popovsky MA. Blood Therapy Med 2002; 2: 1-3 Eritrosit aferezi

    78. MULTIKOMPONENT AFEREZI

    79. ABD de 1999 ve 2001 yillari arasinda eritrosit, trombosit ve plazma ihtiyaci sirasi ile % 12, %15 ve % 18 oraninda artmistir. Kan yoklugu nedeni ile cerrahi operasyonlarin % 13 ertelenmistir Multikomponent toplanmasi (MCC) aktive edilmeden bu sartlar zor kompanse edilebilir

    80. Donrlerin % 95 nin MCC programina geirilebilecegi gsterilmistir. %15-20 MCC programina gemeyi rededetmektedir. Berman KE. Transfusion Med Rev.2004;18:1-10

    81. Multipl aferez rnlerinin toplanmasi, eritrosit de dahil giderek artmakta ve total aferezde zorunlu hale gelmektedir. Bu yolla donr kullanimi gelistirilmekte Kan transfzyon maliyeti dsmektedir. Ayni anda trombosit ve plazma veya eritrosit sspansiyonu toplanmasi rn kalitesi ve WBC kontaminasyonu ynnden trombosit rnn etkilememektedir.

    82. Aferez ncesi trombosit sayisi 200-300x10L oldugunda; Islem sresi 60-90 dakika Toplanan trombosit miktari: 3-5x10 WBC kontaminasyonu: 0.1-0.5X106(% 95 MNH95) Council of Europe RecomendationN.(95)15 on the preparation use and quality assurance of blood components. 10th edition. 2003 version

    83. Plazma trombositlerle birlikte, 250 ml veya 600 ml (PTA, DPTA) kullanilan cell separatre bagli olarak toplanabilir

    85. Double trombosit genellikle trombosit sayisi 290-300x10L, 70 kg. Trombositlerle birlikte eritrosit toplanabilir (ETA, Eritro-trombosit aferezi) Veya ift eritrosit ve trombosit toplanabilir (DETA, double eritro-trombosit aferezi)

    87. Her cihaz zelliklerine bagli olarak minumum 1 (en az 50 gr Hb) Veya 2 eritrosit ile birlikte trombosit toplayabilir (RBC, en az 110 gr Hb) Bu sekilde toplanan rn(RBC) immnolojik yk ve virolojik riski azaltacagi iin bir alici iin idealdir

    88. Hibir cihaz santrifugasyon ile lkositi azaltilmis eritrosit toplayamaz. Ancak cihazin zerine takilan set yardimi ile lkosit arindirma islemi yapilabilinmektedir. Filtrasyon islemi immnmodlasyon ve non-hemolitik transfzyon reaksiyonunu azaltmak iin gerekebilir.

    89. MCA donasyon algoritmasi (San Martino Hastanesi Aferez nitesi)

    90. Manuel ve MCA yntemi ile toplanan eritrositlerdeki degisiklikler

    91. O. Gn MRBC ARBC Glukoz yksek dsk ATP yksek dsk Serbest hb fark yok fark yok Hemoliz fark yok fark yok K+ salinimi dsk yksek PH yksek dsk 49. Gn Glukoz kullanimi dsk yksek Laktat olusumu esit veya yksek esit ATP dzeyi baslangi %70 %43-60 Hemoliz hizi fark yok (<%0.6) fark yok (<%0.6) Serbest hb < 200 mgr/dL <200 mgr/dL Supernatan K+ dsk yksek PH dsk (0.65-0.70/U) dsk (0.65-0.70 /U) Susanne M et al. 2007;47:687-696 Manuel ve MCA yntemi ile toplanan eritrositlerdeki degisiklikler

    94. MCA ekonomik avantajlar

    96. MCA de donr gvenligi MCA, konvansiyonel donasyon kadar gvenlidir. Tibbi personel hastaya yakin Volm replasmani yapilmasi kalsiyum ilavesi Motive edilmis donrler

    97. Hasta iin avantajlar Viral maruziyetin azalmasi Kuru trombosit eldesi ile TRALI sikliginda azalma Hemolitik reaksiyon riskinde azalma Trombosit immn refrakterliginde gecikme Eritrosit immunizasyonunda gecikme

    98. MCA- Sonu MCA, zellikle 2-RBCA nmzdeki yillarda artacaktir. Donr teminine ait yaklasimlar kan temininde arz ve talep arasindaki byyen aigi karsilayamamaktadir. Donor maruziyetini azalttigi ve standart doz eritrosit sspansiyonu sundugu iin; 2-RBCA transfzyon klinisyenleri bu tr rnlerin kullaniminda israr etmektedirler. Hemoglobin ieriginin llerek uygun transfzyon miktarinin hesaplandigi ve eritrosit sspansiyonu transfzyonunun %30 azaldiginin gsterildigi alisma gelecekte yeni yaklasimlara yol aabilir Arslan O et al. Transfusion 2004;44:485488.

    99. Sitrat toksisitesi Islem yavaslatilarak veya Ca+2 verilerek asilabilir Hemoliz Hava embolisi Hipovolemi Platelet sayilarinda kalici dsklk Donasyon sikligi ayarlanmalidir Hemostatik bozukluk

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