Trali !

[spavlis]

I seen lots of posting regarding the new AABB TRALI guidelines. I was wondering if anyone is going to take the alternate route and test all their female donors? I know that this probably wouldn't be cost effective for large facilities, but we are small donor center. Does anyone know who is testing for Anti-HNA or has looked into the testing route?

We are also -- dare I say-- considering having our Blood Bank wash all our HLA positive platelets. ( again we are a small donor center). Has anyone thought about this approach?

I would love to hear some of your feedback or just your thoughts about this topic.

stephanie

[Trek Tech]

Our blood supplier is currently deferring multiparous women as donors for plasma and/or platelets. This seems to be the easiest way to cut the risk dramatically.

[rcurrie]

We are going to do an HLA screen on our female SDP donors. Just once- that's all that is needed. If negative, then there is no problem. If positive, we will defer. As far as plasma, we haven't made FFP from female donors for almost a year now. We collect all the blood we transfuse (14,000 units of RBC a year and 2,000 SDP).

BC

[adiescast]

Our supplier has not made a decision about platelets yet. They are going to 24 hour plasma instead of FFP so they can do the male-only thing.

The problem with only testing once on your female SDP donors is that they could have a pregnancy after you test them and develop antibodies from that exposure. You might need to test initially and after each pregnancy. Then the question is how you would trigger the testing, because most donor software doesn't capture pregnancy data.

[rcurrie]

"The problem with only testing once on your female SDP donors is that they could have a pregnancy after you test them"

Sure they could- but then you just test again. But there is no need to test every time they donate. We have no infrequent donors- we don't allow it. Either they commit, or we don't enter them into the program. So, we would know if and when they replicated.

BC

[n.peters]

Now that the November 2008 deadline has come and gone, does anyone want to share what they are doing to for platelet products and female donors. Did you convert female donors to whole blood only? Are you obtaining history?

Does anyone do the RCPL pools? Are you doing more of those to make up for the loss of female apheresis donors?

[DFields]

:cries:Are you asking about transfusion history as well as pregnancy history?

Are your poicies for mitigating risk in platelet donors the same as for plasma products?

If the female has a history of one pregnancy are you treating her the same as if there were multiple pregnancies?

What about previous platelet donors who are female and multiparous but no problems have been reported in recipients of their platelets, can the Blood Bank Medical Director allow them to continue to donate?

[Debbie]

One blood supplier has opted to test ONLY multiparous female donors. They will test ONCE until the donor reports a change in history of pregnancy/transfusion, then re-test to ensure they aren't positive now. Interestingly enough, when I asked the other day - they have only had 7 donors answer yes to the question about having 4+pregnancies. And, all 7 have tested negative.

I haven't talked to a blood center yet that has opted to stop drawing platelets female donors. The risk in getting a platelet that MAY cause a complication is better than the risk of not getting a platelet at all... Due to the transfusion trends in the US, we CAN defer female donors from plasma altogether, but deferring all females would create a crisis in the platelet supply that would be unacceptable.

Stay tuned... apheresis platelet vendors are working to get platelet additives through the FDA. Within the next year, all apheresis platelets could be plasma poor products with the platelets suspended in additive rather than plasma and this issue could completely go away. (nearly half of all platelets in EU are this way now!)

[DFields]

Where is the FDA as far as approval of a platelet additive solution, rather than having them suspended in plasma?

[heathervaught]

As I understand, Fenwal has a product that is approved:

http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/NewDrugApplicationsNDAs/ucm193789.htm

and others are working on approval. However, the resulting product does not meet the definition of a low-plasma component, and therefore is not considered "TRALI-safe".

[dherbert]

In Transfusion Vol 50 2010 there is an article called "Prevalence of HLA antibodies in remotely transfused or alloexposed volunteer blood donors" by Kakaiya et al . Their conclusions were that "Transfused volunteer blood donors do not appear to have a significantly higher prevalence of HLA antibodies than their nontransfused counterparts." Hopefully this may mean that we could concentrate on the parous females for testing of blood donors which would be a good thing - as long as we can identify and capture that information! Cheers Denise

[heathervaught]

Denise, I know that blood centers who perform testing do focus on the multiparous female and not individuals who have been transfused. There are some centers that test at 2 pregnancies or more, and some who only test at 5 pregnancies or more. And there are some centers, like mine, that have chosen not to implement testing as part of the TRALI mitigation strategy.