Chapter 8: TRANSFUSION AND APHERESIS SERVICES

Version July 2004, Revised 3/17/09

8 TRANSFUSION AND APHERESIS SERVICES

Apheresis

Apheresis is the removal of whole blood from a patient or donor, separation and collection of a component, such as plasma, granulocytes or red cells, and return of the remainder to the patient or donor.

The physician ordering the therapeutic procedure shares responsibility for care of the patient during the procedure.
Cytapheresis and plasmapheresis procedures must be approved by a Blood Bank physician.

Procedure

Details

Plasmapheresis (Plasma
Exchange)

Purpose

Utilized for treatment of hyperviscosity, Goodpasture's syndrome, myasthenia gravis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, thrombotic thrombocytopenic purpura and coagulation factor inhibitor. The common denominator among these diseases is that a beneficial effect is achieved by removal of an abnormal protein or a circulating antibody.

Comments

Outpatient therapeutic plasma exchange can be carried out in the Blood Bank Transfusion and Apheresis Services.

Inpatients may undergo the procedure on the inpatient unit or, if medically stable, in the Blood Bank.

Cytapheresis

Purpose

To ameliorate the symptoms related to severe leukocytosis or thrombocytosis associated with myeloproliferative diseases.

Comments

The technique is considered a stopgap measure to allow time for chemotherapeutic agents to take effect.

Procedure	Details
Red Cells Exchange	Purpose To increase the amount of hemoglobin A in the patient. Comments Scheduled through consultation with Blood Bank Transfusion and Apheresis Service. Outpatient red cell exchange can be carried out in the Blood Bank Transfusion and Apheresis Services. Inpatients may undergo the procedure on the inpatient unit or, if medically stable, in the Blood Bank
LDL Apheresis	Purpose To reduce the amount of low density lipoproteins. Comments Performed as an outpatient procedure in the Transfusion and Apheresis Service.
Progenitor Cell Collections	Purpose To obtain progenitor cells (stem cells) for transplantation Comments Procedures are scheduled through the Human Progenitor Cell Section of the Blood Bank. Progenitor cells collected, as well as cord blood cells and marrow harvested for transplantation, become the property of the University of Michigan Health System and, if not used for the transplant proximate to the time of collection, will be stored for up to five years

Coordination of Autologous and Directed Donations

There is a non-refundable additional charge for each unit of autologous and directed donor blood. These fees are not covered by most insurance carriers and will be assessed at the time of receipt from the blood supplier. If the blood is transfused, there are additional charges for the processing of the donor units. In addition, shipping charges may also apply.
The Blood Bank of the University of Michigan Hospitals and Health Centers does not collect directed or autologous donor units.
To arrange for a directed donation call the Blood Bank Transfusion and Apheresis Service, Monday through Friday, between 8:00 AM and 4:00 pm 734-936-6900) for assistance in arranging such donations through the Southeastern Michigan Red Cross or other blood centers.
It is advisable that one person, possibly the patient, coordinate donation appointments and communicate with the Blood Bank regarding the number of units available.
Donors may schedule appointments from four weeks to five working days prior to anticipated use.
If all of the directed donor units are not used for the patient's treatment within four days of the anticipated transfusion, the remaining blood will be made available for other hospital patients. Therefore, if the scheduled procedure is delayed, and the Blood Bank is not notified, the donated units may be unavailable.
All blood received by the Blood Bank of the University of Michigan Hospitals, including blood designated for specific patients, becomes the property of the University of Michigan Hospitals, and in the event of an emergency, may be used for another patient.

Donation Type	Definition	Advantages	Risks
Autologous Donations	Autologous transfusion is the transfusion of a patient with his/her own blood. Candidates for predeposit autologous transfusion are most often relatively healthy adults or adolescents who will undergo elective or semi-elective surgical procedures with a predictable blood loss.	Avoids the risk of transmission of infectious disease and immunization to foreign antigens. Provides compatible blood for a patient with multiple unexpected antibodies or antibodies directed against high incidence antigens Blood for autologous transfusion can be obtained both intraoperatively or preoperatively	Bacterial contamination Autologous donation is not appropriate for patients with active infection or antibiotic therapy Transfusion to the wrong patient. Prospective autologous donors should have a hematocrit no less than 0.33 (33%). Administer an iron supplement during the period of blood donation to compensate for the red cell loss

Directed Donations

When a patient selects donors to provide blood for his or her subsequent elective transfusion.

The patient should know his or her blood type to expedite selection of compatible donors.

There are no studies that conclusively indicate blood from directed donors is any safer than that from other volunteer donors.

Directed donors must meet donor screening criteria comparable to volunteer blood donors; therefore, infectious disease testing must be completed before release of the blood.

If blood components are needed in excess of those available from directed donors, they will be provided from the volunteer donor supply. The Blood Bank cannot guarantee that the blood collected from designated donors will be suitable or available for transfusion or sufficient for the patient's needs.

Therapeutic Phlebotomy

Procedure	Purpose	Comments
Therapeutic Phlebotomy	Useful in the management of polycythemia vera, idiopathic hemochromatosis, hemosiderosis, Wilson's disease and porphyria cutanea tarda.	Performed for outpatients by the Blood Bank or equipment can be provided for performance of the procedure on patient units.

Outpatient, Off-Site and Home Transfusion

Procedure

Purpose

Comments

Outpatient, Off-Site and Home Transfusion

Outpatient transfusion services are provided by the Cancer Center, 8th Floor Infusion Room and the Transplant Ambulatory Care Unit. Under certain circumstances, transfusion of blood components may be performed off-site, such as in a nursing home or at a patient's residence.

Off-site transfusion services are provided by visiting nurse groups.

Version July 2004