What are Platelets?
The Circulating Platelets (also known as Thrombocytes) are a component of blood which are derived from the megakaryocytes of the bone marrow. A normal Platelet count ranges from 1,50,000 to 4,50,000 per microliter of blood. Having more than 4,50,000 Platelets per microliter of blood is called as Thrombocytosis and less than 1,50,000 Platelets per microliter of blood is Thrombocytopenia. The average life span of circulating Platelets is 8 to 9 days. The main function of Platelets is to stop bleeding along with coagulation factors by clumping and clotting blood vessel injuries.
When is Platelet Transfusion required?
Patients with deficiencies of Platelet Number (Thrombocytopenia) and/or Abnormal Platelet function (Thrombocytopathy) require Platelet Transfusion for the treatment or prevention of bleeding and to survive. Some indications for Platelet transfusion are:
(1) Platelet count less than 5,000 per microliter of blood.
(2) Platelet count below 20,000 per microliter of blood and receiving chemotherapy.
(3) Platelet count below 50,000 per microliter of blood and active bleeding or scheduled for an invasive procedure within 12 hours.
(4) Platelet count below 1,00,000 per microliter of blood with Disseminated Intravascular Coagulation (DIC).
(5) Bleeding with a documented or suspected Platelet Qualitative Defect.
(6) Platelet transfusion is usually not effective in patients associated with immune Thrombocytopenia. The exception is the presence of life threatening bleeding where Platelet Transfusion can be used as a very short term measure.
Collection of Platelets for Transfusion:
Various techniques have been developed to collect platelets for transfusion. One approach is Platelet Apheresis where platelets can be collected from a single voluntary blood donor with the help of an Apheresis Machine.
Platelet Apheresis is collection of anticoagulated whole blood from an eligible voluntary blood donor, its separation into blood components, retention of required platelets and the plasma that platelets are suspended, and returning of the remaining constituents of the blood to the donor. Aphesis Platelets are usually called as Single Donor Platelet (SDP). Each unit of Apheresis Platelets contains about 3.0x1011 platelets suspended in approximately 200 ml of autologous plasma.
We can prepare Platelet Concentrate from freshly collected unrefrigerated whole blood in closed quadra or triple free-blood bags by centrifugation and separation technique using a refrigerated centrifuge machine (e.g. Cryofuge 6000-i).
In this method, Platelet Rich Plasma (PRP) is separated from the donated unrefrigerated whole blood by centrifugation at low speed (soft spin) within four hours after donation. PRP is subjected to another centrifugation at high speed (hard spin) and most of the Platelet Poor Plasma (PPP) supernatant is removed keeping 45 to 65 ml of residual plasma where platelet pellets are suspended. Platelet Concentrates are usually called as Random Donor Platelet (RDP). Each unit of Platelet Concentrate contains about 5.5 x 1010 platelets suspended in approximately 45 to 65 of autologous plasma.
Storage of Collected Platelets:
Collected Platelets (both Apheresis Platelets and Platelet Concentrate) are stored with continuous agitation at 20 degree Centigrade to 24 degree Centigrade in appropriate bags for upto 5 days unless special bags for Platelet are used like CLX. After 72 hours, pH falls below 6.0, compromising platelet viability.
Dosage of Platelet Transfusion:
The number of units of Platelet for transfusion depends on the clinical situation in each patient and type of platelets that are to be infused. Usually one unit of Apheresis Platelets increases platelet count by 30,000 to 60,000 per microliter of blood and one unit of Platelet Concentrate increaseplatelets by 5,000 to 10,000 per microliter of blood.
Usually in an average adult, Platelet Concentrates are administered in pool of 6 units. So, a pool of Platelet Concentrates should increase the platelet count by 30,000 to 50,000 per microliter of blood. One must monitor patient response to platelet infusion by measuring the platelet count post infusion at 10 minutes, 15 minutes or 1 hour. At times, monitoring for 20 hours is also necessary.
MIND OVER MATTER
Q. I am a 30 years old male. I live alone in the city for work purpose, away from my hometown. I don't know anyone here and miss my family very much. I have people around me from work but I am always feeling lonely and homesick. I'm engaged to be married and my fiancée is a lovely girl. But I feel like talking to her 24x7 and that disturbs her. She too is working in an office. I sometimes develop a habit of doubting her. I get angry very often. I feel I don't give her space sometimes. I stay alone and I don't know how to overcome this. Please help me.
Ans: Loneliness does create problems for many. People at times start developing certain insecurities, doubts or obsessions during stress. Remember, marriage is about mutual trust, commitment, respect, care, responsibility and companionship. It calls for mutual adjustments. Try to engage yourself in certain constructive hobbies that match your aptitude/ interests. Try to maintain healthy communication with family and friends. Keep yourself busy by reading good books or listening to light music when you are alone at home. Try not to call up your fiancée at odd times as she too would be busy. Think positive thoughts. Maintain a healthy life style. Avoid alcohol/ drugs. Eat healthy and sleep well. Engage in regular exercise daily.
Q. I am 25 years-old female. I have been married for a year. Since the very beginning, I am having problems adjusting with my husband. He is always arguing for everything. He is very possessive. When we argue he will slap me, and at times, he pushes me. I think it's not normal. If we talk to him, he easily gets very agitated.
Ans: It is important to understand that though we all experience anger very commonly, the issue here is how do we express and manage it. Resorting to physical violence is not acceptable. It can be very destructive and devastating with terrible results as is probably currently being experienced in your marital life.
Try and motivate your husband to consult with a Counsellor/Psychologist at the earliest. It is important to seek some help to help deal with anger issues. In any relationship, physical violence is not acceptable - though in certain cultures it has become almost like a norm - which does not make it right.
Q. Hello Madam, I am in the 8th standard. There is a boy who disturbs me a lot. If I pass by him and his friends, he always passes bad comments at me. I feel scared to pass by them. It is affecting my studies a lot. I keep thinking about it all the time. I never reach my goal. How do I get rid of this?
Ans: What you state is a serious matter. This should not be taken lightly. Please inform your parents at the earliest. They will deal with it in the appropriate manner. Do not engage in any kind of quarrel with this boy. Let the elders deal with it. If possible, for a while, do not move around alone. Take care.
Ms.Gariasi Dutta, MSW (TISS) is Psychological Counsellor with Down Town Hospital, Guwahati. She can be contacted at 98640-55560 or [email protected]