Dear all ..

we are having an issue with icteric Platelets processed from whole blood collections. since february, we had almost 12 donations (differernt mobile and donor room sites, different donor nationalities) with platelets reported as (icteric) !! we rarely had this issue in the past 8 years, but now it's building up and we have a case or two on daily basis. Here's what we have done so far:

notes:

1- All serology tests are negative (we even ran Hep A on some of them and was negative)

2- All samples were tested in chemistry and Billirubin was high

3- Donation samples (which are collected from the sampling arm of Terumo quad sets) were icteric too

any recommendations ?

Hi there...

Immedite few points which I had come to my mind...

Are they cases of congenital hyperbilirubinemia ?

May be calling back those donors, and elicitng some medical / personal history will give more definite clues ?

I am sure , no sensible Blood bank person will use such units just because that they are "serologically negative" !

best wishes ...

Thanks for the quick responces ..

ofcourse the units were discarded !!!! I thought of calling them back, but i'm just wondering what supplemental testing/investigation should be carried out. I am also wondering if someone can share a similar experience and resoultion .

Regards,

With findings such as yours, it is important to speak with the donor and obtain a clinical history. Perhaps there is a medication your donors are taking. Some BCPs will change the color of donor plasma, for example. The donor may benefit from seeing a hepatologist or hematologist to have an bili evaluated.

Kip,

High bilirubin was noted in each sample, so it is not a color issue.

It may not be a donor issue- it could well be a processing issue. Are these SDP platelets? You may need to recalibrate the RBC detector on a certain apheresis machine (see if the units can be traced back to a certain machine). Are the random donor platelets? There may be someone new in the processing center that is being rough on the whole blood units; the units could be over-centrifuged, thus hemolyzing some RBCs; or there may be some other processing problem. Remember the cardinal rules of traceability and trackability, and look at who handled the units in question and what instruments were used in the processing. I bet you have a processing problem rather than a donor problem.

BC

hi, nice that you made a study because we have not done anything like these.

but in my experience, those blood donors who just recently eat solid food turns their blood plasma Icteric.

So we advice donors not to eat at least 2-4 hours... may be try it and compare it has difference and let me know. tnxs!!

Kip,

High bilirubin was noted in each sample, so it is not a color issue.

It may not be a donor issue- it could well be a processing issue. Are these SDP platelets? You may need to recalibrate the RBC detector on a certain apheresis machine (see if the units can be traced back to a certain machine). Are the random donor platelets? There may be someone new in the processing center that is being rough on the whole blood units; the units could be over-centrifuged, thus hemolyzing some RBCs; or there may be some other processing problem. Remember the cardinal rules of traceability and trackability, and look at who handled the units in question and what instruments were used in the processing. I bet you have a processing problem rather than a donor problem.

BC

RBC damage from processing would show as hemolysis not icterus....correct?

Hi there,

I think I also thought the same ...it would be rather haemorrhagic rather than icteric ! fully agree with Trechtech2 !

wishes to all.

engeekay2003

With this economy maybe the donors have upped their alcohol intake.

How high was the bili? Mine is usually high--a few tenths above normal due to Gilbert's syndrome. I don't see why we should trust our visual evaluation of icterus more than a jillion highly sensitive NAT tests. I think I am a sane blood banker and I trust that testing that has been verified millions of times to detect viral infections is way more accurate than my eyeballs. If bilirubin were a good indicator of infectious disease, it would be part of donor testing. As a perfectly healthy donor, I would be kind of annoyed that you threw out my blood.

The above doesn't explain your rash of them. Has anyone studied patients taken a vitamin supplement containing riboflavin? It is quite yellow. I know it makes urine more yellow so I assume it could make plasma yellow. Of course, that doesn't apply in this case since these patients actually had elevated bilis.

Does anyone else sometimes have trouble with slight hemolysis being called icteric? I used to run into that problem with the chemistry department. BBK would call it slight hemolysis and chemistry would call it slightly icteric. More than a couple times I have seen a recollect come back perfect. (Patient Samples)

Along these same lines, what do you do when you have a hemolyzed unit whether slight or gross? In processesing we look at the process, but after storage or if it returned from a consignee do you start the investigation assuming the unit is contaminated and culture (worst case scenario)? Just curious what others do.

Thanks!