Blood Bank - Plateletpheresis

Normally, there are around 150,000 to 400,000 platelets in one microlitre of blood. If an individual’s platelet count is less than 1,50,000, they are said to be thrombocytopenic. On the other hand, if someone has a platelet count above 400,000, the condition is called thrombocytosis. The platelet count is determined with the help of a routine blood test called complete blood count (CBC). Many diseases are associated with a reduced platelet count. All these conditions are linked with failure to form clots which manifests as continuous bleeding. These patients, therefore, require platelet transfusions.

Below are certain medical conditions linked with abnormal platelets or abnormal platelet counts:

• Thrombocytopenia
  This is a condition characterised by production of a decreased number of platelets by the bone marrow. Thrombocytopenia can also develop when too many platelets are destroyed. If the platelet count decreases a lot lower than the normal level, bleeding beneath the skin can occur, which appears in the form of bruises. Low platelet count can also occur when there is profuse, continuous bleeding through a cut in the skin.

Certain factors are responsible for causing thrombocytopenia including liver disease, medications, pregnancy, infections, and abnormal immune system. Following are some signs and symptoms of thrombocytopenia:

• Purpura - characterised by easy or excessive bruising
• Superficial bleeding into the skin looking like a pin-point sized rash, usually on the legs
• Bleeding from the nose or gums
• Prolonged bleeding from accidental cuts
• Presence of blood in stools or urine
• Fatigue
• Abnormally heavy menstrual flows
• Splenic enlargement

If you experience signs and symptoms of thrombocytopenia that are worrisome, you must seek help from a healthcare provider. If the bleeding does not cease to stop or if it does not respond to first-aid techniques, seek immediate medical help and attention.

• Essential thrombocythemia
  In this condition, the bone marrow produces more platelets than normal. Individuals with this condition may have a platelet count more than one million in number. Normally, platelets are used for clotting. When there is presence of abnormal platelets, bleeding may occur in this condition. Other symptoms include formation of abnormal blood clots and blockage of blood supply to the brain or the heart. The exact cause of thrombocythemia of this type is not known. However, the known cause in some cases are the changes in the bone marrow cells.
• Secondary thrombocytosis
  This condition also occurs due to excessive platelet number. It does not occur secondary to an issue with bone marrow, rather the bone marrow is stimulated due to other disease or condition to produce more platelets than normal. Causes of secondary thrombocytosis include certain cancers, anaemia, inflammation, infection, and reactions to medications.
  
  Symptoms usually are not that severe as people with this type of thrombocytosis have a lower risk of bleeding and blood clots than those having primary or essential thrombocythemia. When there is an improvement in the condition causing secondary thrombocytosis, the platelet count also returns to normal levels.
• Platelet dysfunction
  Poor platelet function is linked with various rare diseases. The platelet count is normal in this condition, however, the platelets fail to function normally. Certain medications like aspirin can cause this condition.
• Trapped platelets
  Spleen is a tiny organ that lies on the left side of the abdomen. Its work is to filter unwanted waste products from the blood and defend the body against infections. Splenic enlargement can occur because of many different disorders. An inflamed spleen houses too many platelets, reducing the number of platelets in the bloodstream.

Decreased production of platelets

Platelets are generated in the bone marrow. Certain factors are responsible for a reduction in platelet production, including:

• Some types of anaemia
• Chemotherapy drugs and radiation therapy
• Leukaemia and other cancers
• Heavy alcohol consumption
• Viral infections, such as hepatitis C or HIV
• Increased breakdown of platelets

Some medical conditions make the body damage platelets or use those up faster than they are generated. Due to this, a shortage of platelets occurs in the bloodstream. Following are examples of such conditions:

• Pregnancy
  Thrombocytopenia occurs due to pregnancy. It is generally not severe, and improves immediately after delivery.
• Immune thrombocytopenia
  This type of thrombocytopenia occurs secondary to autoimmune diseases including rheumatoid arthritis and systemic lupus erythematosus. The body’s immune system mistakenly attacks the platelets and damages them. If there is no known cause of this condition, it is called idiopathic thrombocytopenic purpura. It is more common in children.
• Bacteria in the blood
  Platelets are destroyed by some bacterial infections that affect the blood.
• Thrombotic thrombocytopenic purpura
  It is a relatively rare condition that occurs when small blood clots suddenly develop throughout the body, using up a large number of platelets.
• Hemolytic uremic syndrome
  It is a relatively rare disorder that causes an abrupt decrease in the platelet count, destruction of red cells, and symptoms suggestive of kidney failure.
• Medications
  The platelet count in the blood can fall due to certain medications. Sometimes, the immune system is confused by drugs, so platelet destruction occurs.

Complications of low platelet count

When there is a fall in platelet count below 10,000 platelets per microlitre, life-threatening internal bleeding may occur. Even though it is uncommon, severe types of thrombocytopenia can lead to life-threatening bleeding in the brain.

Below are some eligibility criteria for Single Donor platelet donation:

• The donor must have accessible veins on both arms.
• Repeat donors are preferred. Repeat donors are those who have donated blood a few times in the past.
• The age of the donor should be between 18 to 55 years.
• His weight should be above 55 kgs.
• Haemoglobin level of the donor should be at least 12.5 g/dl.
• Platelet count should be above 1.5 lakhs per microlitre.
• Time interval between two successive platelet donations must be a minimum of one week. A person should not donate platelets more than twenty four times per year.
• A platelet donor should not have oily food before platelet donation.

Below are some eligibility criteria for blood donations:

• The weight of the donor should be at least 55 kg
• His haemoglobin level should be a minimum of 12.5 gm%
• The age of the donor must be in the range of 18 years to 65 years.
• Time interval between two successive blood donations should be at least three months.
• The donor should have had an adequate meal before blood donation.
• A voluntary blood donor should be negative for any infectious disease prior to donating blood.
• The donor should have a negative history for lung or heart disease or a seizure disorder.
• All details regarding medication he is currently taking should be shared with the medical officer prior to donating blood.
• The donor should avoid heavy work or long driving after donating blood..
• Blood parameters like haemoglobin level, platelet count, and haematocrit should be checked prior to donation. Platelet count must be at least 150,000 per microlitre of blood.
• Donors should screen negative for diseases transmissible via blood including Hepatitis B & C, HIV, platelet count, and Syphilis.

Screening of the donor for platelet donation

A haemoglobin screening is performed on platelet donors just like for a blood donor. A confidential medical history is collected and a physical examination is done to check the donor’s vital parameters including pulse rate, blood pressure, temperature, and haemoglobin level. Blood samples are taken from the donor and forwarded to the laboratory for certain investigations including malaria screening, triple serology, and complete blood count. The results are valid for only 7 days to 1 month after the sample is collected. If platelet donation occurs after one month, the donors are tested again for the above parameters.

Some facts a platelet donor should know:

• Smoking must be avoided before platelet donation.
• The platelet donor should not consume oily rich/ fatty foods before donation
• Medications like aspirin should be avoided for 72 hours before donation.
• For serial plateletpheresis the time interval between two successive procedures should be at least 72 hours.
• A donor can donate platelets for a maximum of 24 times in a year or two times in a month.

The plateletpheresis procedure has an immediate and powerful impact on the life of a cancer patient. The platelets are transfused to a patient within a week and they could play a major role in keeping them alive. Platelets are mostly used for cancer patients, but also help patients with undergoing open-heart surgery and organ transplants or blood disorders. Because platelets need to be transfused within a week of collection, platelet donors are constantly needed to keep the supply stable.

Does your loved one need a platelet transfusion in Indore? Are you a platelet donor? If you are looking for a centre for plateletpheresis in Indore, you can visit the Blood Centre and Transfusion Medicine Department at Kokilaben Dhirubhai Ambani Hospital, Indore and seek help. Our department is equipped with state-of-the-art infrastructure and advanced medical instruments. Our staff members are highly qualified and experienced and deliver all services with utmost care and professionalism. International protocols and quality standards are followed during all the procedures.