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You may save a life with your donation Platelets donation is a safe and simple procedure

BLOOD is a vital resource that cannot be manufactured. Although there are attempts, some even groundbreaking, to produce artificial blood from human stem cells, manufacturing blood on an industrial scale still seems to be in the realm of gory science fiction. Blood donations are fairly common and attract regular individual involvement or participation through seasonal drives and in times of emergencies. However there is another type of donation, called component donation or Apheresis donation, which is also essential to supply specific components of blood. Dr Rania Madkour, Head of Apheresis Donation Department at Central Blood Bank, sheds light on one such lesser known component and the urgent need for its donation.

Question: Can you begin by telling us what are platelets?
Answer: Platelets are a type of cells present in blood. Blood is composed of red blood cells, white blood cells and platelets and the fluid part is plasma. Platelets are small colourless disc-shaped cells without a nucleus, found in large numbers in the blood. Platelets are important component of blood because they are the first line of clotting process. If we have defective platelet count and /or function, a person will continue bleeding when he or she suffers an injury.
 

Q: What is the range of a normal platelet count?
A: A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called thrombocytosis; having less than 150,000 is known as thrombocytopenia.
 

Q: How does one check their platelet count?
A: You can check your platelet count from a routine blood test called a complete blood count (CBC).
 

Q: What are the symptoms of thrombocytopenia? What causes a low platelet count?
A: When you don’t have enough platelets, symptoms include easy bruising, and frequent bleeding per gums, nose, or GI tract … etc
Your platelet count drops when something is preventing your body from producing platelets. There are a wide range of causes, including medications, inherited conditions, certain types of cancer, such as leukemia or lymphoma, chemotherapy treatment for cancer, kidney infection or dysfunction and too much alcohol.
Also, a person can have a normal platelet count but possess a defect on account of function. So in the case of platelet dysfunction, a person may have a sufficient platelet count but the platelets don’t aggregate. We can do a platelet function test to determine if there is a malfunction.
 

Q: Who commonly needs platelet support in Kuwait?
A: In Kuwait, requests for platelet donations come mostly for cancer patients, especially those with blood cancer. Platelet support is normally given to patients who are undergoing surgeries; this can be open-heart surgery or any other major surgery.
 

Q: Who can donate platelets?   
A: Almost anyone can be a platelet donor. The qualifications are the same as for whole blood donations. You can donate platelets through a process called apheresis, which is a technique of selectively withdrawing a single component of blood.
The optimal age for a platelet donor ranges from 17-70 years old. We prefer those who have previously donated whole blood to serve as a basis of whether his or her body will be able to tolerate the platelet aphaeresis or not. But even if a person has not donated blood in the past, we can still accept him or her as a donor if they are healthy and pass the medical and the viral screening tests.
It is very important that a platelet donor not to be on certain medications that affect the platelets. These are mainly aspirin or analgesics. The only acceptable analgesic is paracetamol or what is commercially known as panadol. These do not affect platelets.
 

Again, apart from this, all that applies to the whole blood donation, applies to platelet donation. A donor should be able to pass a simple medical check up which includes a measurement of their height and weight. He or she should weigh at least 55 kgs, the donor’s height is important to describe the total body volume because we are processing his blood in the machine. Vital signs like blood pressure and temperature are checked and we do a complete blood count in order to determine if the donor has an acceptable platelet count before the donation.
 

Q: What conditions would disqualify someone from being a platelet donor?
A: Women who have a history of pregnancy, even if they have had a miscarriage are not eligible as well as all males and females who have had a blood transfusion. This is because mixing blood creates certain antibodies that may harm the patient who is receiving the platelets. So they are not eligible at all. Most of our donors are generally males and unmarried females.
 

Q: What is the optimal platelet count for a donor?
A: People who have a platelet count between 150,000 to 200,000 platelets per microliter of blood, is normal for the individual but not optimal for platelet donation. We require donors with a higher count so that the post donation count will not be affected. For donation, we usually accept from 180,000 platelets per microliter of blood and upwards to 450,000 platelets per microliter of blood.
 

Q: Can you describe the process of aphaeresis?
A: The word apheresis means ‘a taking away’ and thus implies the separation of blood components. What this machine does is, it takes part of your blood and separates each component by a centrifugation method i.e. separate each component according to its density. Usually the heavier component is the red blood cells, followed by the white blood cells and after that is the platelets and plasma.
 

Q: Why can’t you collect platelets from whole blood?
A: We can collect platelets from whole blood and it is not hazardous but the process of apheresis is more effective. In this process, we are collecting the six units (therapeutic platelet dosage) from a single donor. In the case of whole blood donation, the same dosage amount would require a collection from six different donors. This, in turn, means six different immunological backgrounds and antigens. I would be exposing the patient to different antigens, which may lead to sensitization especially in the case of patients who need regular transfusions.
Also the quality of platelets pooled is less than the quality of platelets from a single donor. Platelets coming from apheresis are filtered, not contaminated with blood, clear, and efficient.
 

Q: How long does the process take?
A: A donor may stay between one to one and a half hours, it depends on the individual’s height, weight, blood haematocrit and platelet count.
 

Q: During the process of apheresis, can the donor do other tasks?
A: Actually, in old procedures, two different needles were used, one in each hand. One needle would draw out the blood and the other would return it. Nowadays, all the new techniques use a single needle to draw and return the blood. So the donor’s other hand is free. TV screen is available in the donation area to entertain the donor during donation, also some donors used to read books, or use their personal tablets and ipads
 

Q: Does a regular platelet donor have to donate platelets exclusively?
A: A platelet donor can also give whole blood donations from time to time. But when a donor gives a whole blood donation, he has to wait two months to give any other kind of donation, either platelets or whole blood. Usually we just take note of what the last donation for a particular donor was and count the deferral or waiting period accordingly.
 

Q: What is more needed, platelets or whole blood donation?
A: Both are needed but getting donors for whole blood donation is easier. People are more aware of regular blood donations so they come by themselves, voluntarily to donate blood. Also, we do mobile campaigns for regular blood donations and it takes 5-10 minutes to collect whole blood.
Platelet donations, on the other hand, are not as well known. Many people think that since it is a component of whole blood, so we can simply extract it from whole blood. But apheresis, for reasons I mentioned earlier, is really the best practice for collecting platelets.
The donation time in the case of platelet pheresis is relatively long so this is not preferred by most people. We are usually under stress because of huge demand of platelets. That is not the case for whole blood, we usually have a steady supply of that.
Another important factor I want to highlight is that platelets have a shorter shelf life than whole blood.
 

Q: What is the shelf life of whole blood and platelets?
A: A unit of whole blood can be stocked up to 42 days which means we have a wider supply. Platelets, on the other hand, only stay for five days. After five days if the platelets are not issued, it expires. So sometimes, if I have a family come in to donate platelets, I will distribute the donors on different days to counter any eventuality of running out of platelets.
 

Q: How many whole blood and platelet donations does the blood bank receive on a daily basis?
A: On a daily basis, it varies from 22 donors up to 30-35 donors for platelet donors. For regular blood donors, because we have two shifts, we receive up to 200 donors. This number goes up if there is a mobile campaign.
 

Q: How often can a person donate platelets?
A: It takes 2 days to replace the platelet count. So a donor can donate platelets every two days but a maximum of twice a week. The maximum per year is 24 platelet donations. Our protocol here at the Central Blood Bank for regular donors is 12 donations per year. But in cases of emergency or if there is a donor that matches a specific requirement we can do it more frequently but not exceeding the 24 donations/year and this is totally safe and does not affect the body adversely.
 

Q: Are there any side effects associated with platelet donations?
A: It’s not really a side effect but there are some symptoms that a donor may feel during the donation. In order to collect the blood outside the body and process it we have to add anti coagulants. This is safe because it is also transferred to the patients receiving the blood. But it can cause some symptoms like numbness around the mouth, a tingling in the extremities, feeling cold.
We usually give the donor calcium tablets at the start of the procedure to control these symptoms and we know how to manage it. In case the symptoms persist, we can give the donor an additional calcium tablet or decrease the flow rate to manage these symptoms. It must be noted that these are temporary symptoms and when the donation is done and the needle is removed, the symptoms fade away.
 

Morever, all side effects and complications that happen in whole blood can happen here. But we have noticed that in platelet donations these side effects are marginal because of the longer duration of the procedure. Since the blood is taken out very slowly and returned back to the body very slowly, the hemodynamics are much better. In regular blood donations, there is no compensation and the donor may feel hypo-volemia or hypotension. This is not so frequent for platelet donations.
 

Q: Are there any other types of blood component donations?
A: On the same machine, along with platelet donations, we also take plasma. This is actually better for the donor because it reduces the effect of the anticoagulants. The volume is easily replaceable since it is just fluid. If a donor drinks a good amount of fluids he or she should be fine within two days.
On the other hand there is another type of component donation known as double RBCs donation. Since it is a component separation machine, we can configure it to take two units of packed red blood cells from the donor in one donation session. This is extremely beneficial in the case of rare groups or phenotypes where a donor may be the only match to a patient. Of course, there is a higher eligibility criteria than the whole blood — higher haemoglobin and even the deferral period is longer at four months interval. But this is very helpful in stock management and rare groups. Another advantage of using this process is that the product is ready because I already have the packed cells. In a regular donation, you would have to process these units, take it through the centrifugation process.
 

Q: What should a donor keep in mind on the day of the donation?
A: There are some recommendations that you have to follow pre and post donation. We provide all our donors with pre donation instructions. He or she needs to have light meals for dinner on the previous day and a light breakfast in the morning of the donation in order to avoid having fatty plasma. He or she should have good sleep, not take aspirin or analgesics for at least five days prior to the donation. We recommend a calcium rich diet to minimise the symptoms but many people don’t feel any symptoms at all.
 

Q: What about people who smoke? Are they eligible donors?
A: Smokers can donate, but its recommended to refrain from smoking for at least half an hour before the donation and two hours after. Usually smoking causes an increase in the haemoglobin level, which may cause donor’s deferral from platelet donation if reached very high levels.
 

Q: Are there any safety concerns with regards to infection?
A: It is important for all potential donors to know that there is no possibility of infection transmission because we use disposable sets that are sealed, sterile and exclusive to each donor. The disposable set contains the needle that we prick in to the donor plus all of the tubing that the blood will pass through. The blood will not touch any part of the machine.
I must also point out that we don’t do therapeutic plateletpheresis on the machines used for platelet donation, it is done on another type of machine and in separate room. So there is no way that someone infected will sit on the machine.
Many people think that it is like dialysis of the kidneys. In kidney dialysis, the user is a patient and even if he is infected with a viral infection, he can sit on the machine. But in this case we are selecting only healthy donors.
 

Q: What is your hope for the future?
A: I hope that people get oriented about the platelet donation and the high need of it because sometimes we encounter really miserable cases where the patient has a platelet count of one or five. Platelets or blood is not something that can be manufactured. If we don’t have donors, we have nothing to help the patients.
A donor may spend one hour but your body compensates for this loss within two days. It will not cause you anaemia if you have low haemoglobin or borderline haemoglobin because we return the red blood cells back to you.

It is a safe and simple procedure and the effect on the body is less. It’s really demanded and my hope is that people have this knowledge and they voluntarily come. If you donate one hour of your time a month, you may save someone’s life.
Platelet donations at the Central Blood Bank are conducted during these hours–
Sunday to Thursday (Except Tuesday): 7 am - 2:30 pm
Tuesday: 7 am - 5 pm
Saturday: 7 am - 12 pm
Friday: No platelet donation (only whole blood donation).

biography

Dr Rania Madkour graduated from Faculty of Medicine at Cairo University in 2001, completing her Masters Degree in Clinical and Chemical Pathology in 2009 with a specialization in hematology and blood banking. She received her certification from National Association for Healthcare Quality (NAHQ) as Certified Professional in Health Care Quality (CPHQ) in April 2012. She has worked as a blood bank specialist for seven years at the Egyptian National Blood Transfusion services before joining the Kuwait Central Blood Bank in May 2010 where she served as a physician until April 2011 and later as the Apheresis Unit Supervisor.

By Cinatra Fernandes
Arab Times Staff


By: Dr Rania Madkour

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