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NEW INNOVATIONS IN TRANSFUSION MEDICINE

NEW INNOVATIONS IN TRANSFUSION MEDICINE. Dr.( Prof.) R.N. Makroo Director Dept . of Transfusion Medicine Rockland Hospital New Delhi. Topics to be discussed. Multicomponent Apheresis Recombinant Products Bacterial detection Pathogen Inactivation Hematopoietic Stem cells

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NEW INNOVATIONS IN TRANSFUSION MEDICINE

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  1. NEW INNOVATIONS IN TRANSFUSION MEDICINE Dr.( Prof.) R.N. Makroo Director Dept. of Transfusion Medicine Rockland Hospital New Delhi

  2. Topics to be discussed • Multicomponent Apheresis • Recombinant Products • Bacterial detection • Pathogen Inactivation • Hematopoietic Stem cells • Patient Blood Management • Artificial Blood • Gene Therapy • Innovations in TM • Advances in Safe Transfusion Practices • Evolution in hemoglobin screening in donors • Blood collection and anticoagulants • Evolution in blood bags • Great Strides in immunohemat • Blood group typing over the years • TTI testing • Component Processing and Leucoreduction • PRP

  3. Introduction • Various innovations have taken place in the field of transfusion medicine to enhance the blood safety • Implementation vary from developed countries to developing and under developing countries. • Only Selective innovations are being followed in developing countries including India because of cost constrains & lack of policy decisions.

  4. Introduction • It was in 1971, Professor Richard M.Titmus at London school of Economics published the concept of Gift Relationship: from human blood to social policy. • The impact of this was far reaching to change the policy of collecting blood from paid blood donors to voluntary blood donors as this was proved after testing that infection rate in voluntary blood donors is less compared to voluntary blood donors

  5. Innovations in T.M • To provide safe blood components. • Advocates the use of specialized blood products. • Search for alternatives to blood transfusion. • Blood from culture plate / clonal blood. • Clinical transfusion medicine. • Incorporation of molecular biology, biotechnology & bio-informatics in the field of T.M.

  6. Advances in Safe Transfusion Practices • Various innovations have taking place in the field of transfusion medicine since the last few years, some of which are being increasingly adopted in different parts of the world while some of them are still in the initial stages. • These can be generally grouped into the following categories: 1. Advancements at the collection, processing and storage level 2. Testing technologies 3. Better Patient Blood Management

  7. EVOLUTION OF HEMOGLOBIN SCREENING IN DONORS NONINVASIVE METHODS

  8. BLOOD COLLECTION AND ANTICOAGULANTS ACD CPD CPDA Additive Solutions (AS-3 to AS-7)

  9. Evolution in the Blood Bags Single Blood bags Primary bag Triple Bags Top & Top Plasma Platelet conc. Buffy coat Red Cells Quadruple Top and Bottom Bags Quadruple Bags with inline filters and Diversion Pouch

  10. GREAT STRIDES IN IMMUNOHEMAT.. PAST PRESENT FUTURE

  11. Blood group typingover the years

  12. New And Emerging Pathogens:A Risk That Current Safety Measures Can’t Eliminate

  13. Progress in Detection of Transfusion-Transmitted Pathogens Shorter window period to detection SurrogateMarker AntibodyTesting Viral Antigen Detection Viral RNA/DNA Detection • Serum ALT • T-cell count • Anti-HIV • Anti-HBc • Anti-HCV • Anti-HTLV • HIV p24 Ag • HBsAg • HCV Ag • NAT • HIV-1 • HCV • HBV • WNV NAT is the only direct test for the infectious agent

  14. WINDOW PERIOD :A known source of transfusion-transmitted infections.

  15. COMPONENT PROCESSING Automated Component Separators Manual Component Separation

  16. Universal shift to Leucoreduction

  17. LEUCOCYTES CONTAMINATE BLOOD COMPONENTS 1010 109 108 107 106 105 104 Whole Blood Buffy Coat Depleted Red Cells Platelet Concentrates (6 units) Apheresis Platelets UK / Holland / USA Guidelines European Guidelines

  18. WHY LEUCOREDUCE ? • Reduced alloimmunization • Reduced transmission of viruses & other intracellular pathogens • Potentially reduced immunomodulation, post-operative infection and tumor spread • Reduced febrile non-hemolytic transfusion reactions with with pre-storage filtration

  19. RFID and Blood Component Tracking

  20. Platelet Rich Plasma

  21. Multi component Apheresis • The multi component Apheresis can be the answer to some single or recurrent problems: • Concerning the donors: time needed for donation, possibility to be available, distance from blood centre… • Concerning the blood products: • Increase of platelets needs • Increase of red blood cells in some precise blood groups like O Rhesus negative, O CCDee...

  22. The Collection System for collection of two units of Leucodeplited Red Cells ALYX Hemonetics MCS+

  23. Recombinant Products • Recombinant factor VIII e.g. Recombinate • Recombinant factor IX e.g. Benefix • Recombinant factor VII (Novoseven) • vWF, ATIII, • Alpha1 protease inhibitor • Hb vaccines, • R Hb • Haemopoietic growth factors EPO,G-CSF, GM-CSF,TPO,ILS,TNF

  24. Bacterial detection of blood components especially platelets Bacterial Detections Systems Verax PGD Test Pall BDS System BacT/Alert System

  25. How Does it Work? Pall BDS • The Sample Set is sterile connected to the platelet product on the day following whole blood or apheresis collection (24 hrs) • 2 mL of the platelet product is expressed through the filter into the sample pouch • The sample pouch is disconnected from the Sample Set and incubated at 35ºC for 24 hours (after 24 hours, the sample pouch is returned to room temperature; 22ºC) • At any time following the incubation, the O2 content in the air is measured using the O2 Analyzer. • Clinical trials show that samples tested at 30 hours and 48 hours showed higher percent positive (sensitivity) results.

  26. Bac-T/Alert What is it? • BacT/Alert is an automated microbial detection system designed to detect bacteria and fungi in blood products: • Red Cell Concentrates • Plasma • Platelets • The complete system consists of: • an Automated Incubator • a Host System (computer, printer, bar code reader) • a Sampling System (sterile dock pouch) • Media (culture bottles)

  27. Bac-T/Alert • ~ 24 hours after collection*, a Day 1 sample is taken • The sample** is transferred into a 30cc culture bottle which has culture media (aerobic & anaerobic) • The bottles are loaded into the incubator at 35°C and inoculated for a minimum of 24 hrs • The bottles contain colorimetric sensors which change from dark green to yellow in the presence of CO2 • The system than notifies the laboratory with visual & audible alarms • Sensors scan the bottles every 10 minutes thus ensuring rapid detection of any bacterial contamination * Delaying when sample is taken = Better detection efficiency ** Higher sample volume = Better detection efficiency

  28. Positioning Pathogen Inactivation • Position: • Bacterial Detection Systems only detect Bacteria (with significant limitations) • Pathogen Inactivation is a Comprehensive Approach toward Blood Safety Bacteria Introduced during collection + + Emerging viruses Leukocytes Adverse immune responses and transfusion reactions “The Next Virus” + + False Negatives Known Pathogens Limits of detection of current assays (e.g., window-period issue) For which no assay is available

  29. The INTERCEPT Blood system for platelets uses ultraviolet (UVA) light and the innovative compound amotosalen HCI to permanently disrupt DNA and RNA replicaton and prevent prolifertion of susceptible pathogens.

  30. MIRASOL PATHOGEN REDUCTION

  31. HemAtopoieticStem Cells • Hematopoietic stem cells are pluripotent cells capable of indefinite cell revewal and differentiation into any cell lineage • 1% of B.M. cells and 1/100,000 PBC are stem cells. • Highly purified autologous heamotopoetic stem cells expanded by in vitro culture.

  32. SOURCES OF HAEMATOPOIETIC STEM CELLS (HSC) • Bone Marrow • Growth Factor Mobilised Peripheral Blood Stem Cells (Pbsc) • Placental Umbilical Cord BloodHsc

  33. PBSC’s COLLECTION • Hematopoietic G.F used to mobilise PBSC’s from B.M. • PBSC’s collection should be timed when the number of CD34+ is maximal and collection to be continued until an adequate number of cells have been obtained. Most commenly used targets are > 2 x 106 CD34 cells per Kg. • Major limitations of using HLA matched related sibling donors in HSCT • Only 30% to 40% of recipients have a HLA - matched related family donor Search for an alternate source of HSC

  34. From Lab to Clinics…..Patient Blood Management • A series of ‘rights’ • Right Patient • Right Product • Right Reason • Right Time

  35. Artificial blood • Unmodified & modified hemogobin solutions Stroma free hemoglobin Cross linked hemoglobin Micro encapusulated hemoglobin • Per Fluoro carbon compound Fluosal - DA as oxygen carriers • Platelets substitute like infusible platelet membrane or fibrinogen coated albumin particles. • Recombinant proteins to replace coagulation factors.

  36. NEWER & EVOLVING CONCEPTS IN T.M • Enzymatic removal of antigens of red cells to convert groups A, B or AB to group O. SPECULATIONS • Bio-technology may generate blood products for population on other planets. • Synthetic blood products may make T.M a non-entity.

  37. “Report on Science” Cloning Red Blood Cells in Plant British Broadcasting Corporation (BBC, London, UK) 7 March 1997 U CAN GET BLOOD FROM A TURNIP !!! Thank you !

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