Transcript PowerPoint-presentatie

Presence of medication taken by blood donors
in plasma for transfusion
A. van Tilborgh, J. Wiersum, M. Schipperus
D. Touw
F. Hudig
3-6-2013
ISBT Regional Congress Amsterdam
Case historie
• 70-year-old female patient, von Willebrand disease type II, with known
allergies (plasters, barium contrast, fruit, penicillin?)
• Fractured collar bone
21/1
14.00 hrs
start platelet transfusion, BP 160/71
21/1
14.10 hrs
bronchospasm, glottis edema, urticaria,
hypotension
• Tavegil and hydrocortisone: quick recovery (BP 180/90)
• No IgA deficiency
TRIP report:
3-6-2013
Anaphylactic reaction,
imputability probable, severity grade 2
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year TRIP
receives several
reports
like this
one.
• Every
The category
of anaphylactic
reaction,
defined
as allergic
reactions with systemic features such as airway obstruction, fall
in blood pressure, vomiting or diarrhoea, accounts for the
largest number of serious transfusion reactions.
TR severity grade 2 or higher 2008-2012
• In most cases no cause is found for these reactions.
serious anaphylactic TR
serious TR
3-6-2013
ISBT Regional Congress Amsterdam
anaphylactic TR 2008-2012
• TRIP data show that anaphylactic reactions occur relatively
frequently during or after transfusion of plasma or platelet
concentrates. Most platelet units are also rich in plasma.
• Data from blood services show that approximately 10% or more
of plasma donors use medication which is permitted under
donation guidelines.
Distributed blood components
3-6-2013
RBCs
platelets
plasma
combination
other (drain blood)
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This exploratory study investigated the presence of drugs or
drug metabolites in donor plasma after quarantine, storage and
thawing.
Only samples for which the blood supply organisation confirmed
that the donor had consented to research use were included.
Thawed FFP  rejected for transfusion  sample 5 ml
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ISBT Regional Congress Amsterdam
I-Tox screening
The samples were analysed for approximately
800 drugs or drug metabolites
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ISBT Regional Congress Amsterdam
All detectable substances that were recognised as drug or drugmetabolite
were considered a positive screening result
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87 samples have been processed
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87 samples
negative
positive 1 substance
postive 2 or 3 substances
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ISBT Regional Congress Amsterdam
87 samples
3 (3%)
11 (13%)
negative
positive 1 substance
73 (84%)
3-6-2013
postive 2 or 3 substances
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The most prescribed drugs in The Netherlands in 2009/2010
• Metoprolol
• Omeprazol (also OTC)
• Acetylsalicylic acid (also OTC)
We expected that frequently prescribed drugs or over the counter drugs
were most likely to be found in some of the donor plasma units.
3-6-2013
ISBT Regional Congress Amsterdam
Type of drug
Name
Freq
Antidepressant
(SSRI)
Paroxetine
Citalopram
1
1 (C1*)
Antipsychotic
Pipamperon 1 (C1*)
Quetiapine 1 (C1*)
Antihypertensive Valsartan
(ARB)
Telmisartan
2
3 (C2*)
Ca channel
blocker
Amlodipine
1 (C2*)
ß-blocker
Metoprolol
1 (C2*)
Antidiabetic
Glicazide
1
Publication / FTK# Lareb$
* C. = combination of medication
# Publication Yes – No / mentioned in FTK = Farmacotherapeutisch Kompas
$ Lareb = Netherlands Pharmacovigilance center, number of reports in database
3-6-2013
ISBT Regional Congress Amsterdam
Type of drug
Name
Freq
Publication / FTK# Lareb$
Antidepressant
(SSRI)
Paroxetine
Citalopram
1
1 (C1)
N /very rare(<0.01%)
Y/?
9
6
Antipsychotic
Pipamperon
Quetiapine
1 (C1)
1 (C1)
N/?
N /sometimes (<1%)
2
Antihypertensive Valsartan
(ARB)
Telmisartan
2
3 (C2)
N/?
N /rare (<0,1%)
3
1
Ca channel
blocker
Amlodipine
1 (C2)
N /very rare(<0.01%)
3
ß-blocker
Metoprolol
1 (C2)
N/-
9
Antidiabetic
Glicazide
1
N/-
-
* C. = combination of medication
# Publication Yes – No / mentioned in FTK = Farmacotherapeutisch Kompas
$ Lareb = Netherlands Pharmacovigilance center, number of reports in database
3-6-2013
ISBT Regional Congress Amsterdam
Type of drug
Name
Freq
Publication/FTK
Antidepressant
(SSRI)
Paroxetine
Citalopram
1
1 (C1)
- / very rare(<0.01%)
Y/?
9
6
Antipsychotic
Pipamperon
Quetiapine
1 (C1)
1 (C1)
-/?
- / sometimes (<1%)
2
Antihypertensive Valsartan
(ARB)
Telmisartan
2
3 (C2)
-/
- / rare (<0,1%)
3
1
Ca channel
blocker
Amlodipine
1 (C2)
- / very rare(<0.01%)
3
ß-blocker
Metoprolol
1 (C2)
-/-
9
Antidiabetic
Glicazide
1
-/-
-
PPI (OTC)
Omeprazol
1
Y / rare (<0,1%)
16
NSAID (OTC)
Naproxen
4
Y / rare (<0,1%)
50
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Lareb
ISBT Regional Congress Amsterdam
Type of drug
Name
Freq
Publication/FTK
Lareb
Antidepressant
(SSRI)
Paroxetine
Citalopram
1
1 (C1)
- / very rare(<0.01%)
Y/?
9
6
Antipsychotic
Pipamperon
Quetiapine
1 (C1)
1 (C1)
-/?
- / sometimes (<1%)
2
Antihypertensive Valsartan
(ARB)
Telmisartan
2
3 (C2)
-/
- / rare (<0,1%)
3
1
Ca channel
blocker
Amlodipine
1 (C2)
- / very rare(<0.01%)
3
ß-blocker
Metoprolol
1 (C2)
-/-
9
Antidiabetic
Glicazide
1
-/-
-
PPI (OTC)
Omeprazol
1
Y / rare (<0,1%)
16
NSAID (OTC)
Naproxen
4 (C3)
Y / rare (<0,1%)
50
Anabolic steroid
Metenolon
1 (C3)
-
-
Preservative
Methylparaben 1
Y
-
http://www.lareb.nl/LarebCorporateWebsite/media/publicaties/Anafylactische-reacties-op-NSAID-s.pdf
ISBT Regional Congress Amsterdam
3-6-2013
Conclusions
• It is possible to detect medication in donor
plasma after freezing, quarantine, storage and
thawing
• It cannot be excluded that medication taken by
the donor in plasma for transfusion could
cause an anaphylactic reaction in the recipient
3-6-2013
ISBT Regional Congress Amsterdam
3-6-2013
ISBT Regional Congress Amsterdam