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In Saudi Arabia our greatest issue is the availability of sufficient blood donors to meet the increasing demand for blood products. Unfortunately there is no central blood banking system so each hospital must be self-sufficient and manage its own blood supply through blood donations. I am campaigning for a central blood system in Saudi Arabia. One of my major goals is to see more blood products made available to patients who need them. We set up a charity for haemophilia patients, through which we are helping to raise awareness and campaign for funds and availability of factor replacement products. Challenges make life more interesting.
When a patient needs plasma, they have their ABO blood group validated. The request will go to the blood bank, which will recommend the best product for treatment based on the patient’s blood group and the quantity needed. We use fresh frozen plasma (FFP), and for patients with rare blood groups we use octaplas® The plasma is taken out of the freezer and thawed to body temperature: 37° Celsius.
The most common reasons for plasma transfusions are surgical procedures. Surgeons give prophylactic infusions of plasma to prevent bleeding during surgery. Surgeons are concerned about bleeding during cavity, abdominal, intracranial and orthopaedic procedures. The surgeons tend to be proactive to avoid bleeding, especially during organ transplants. The second most common group of patients with long-term use of plasma are those with rare bleeding deficiencies, such as factor X or II. These patients are prone to bleeding especially with trauma, injury, excessive exercise and surgery. They require regular plasma infusions to increase their coagulation factor levels.
We use a large volume of plasma for the treatment of patients with thrombotic thrombocytopenic purpura (TTP). In our registry we have 100 TTP patients. TTP is a rare, life-threatening condition associated with severe ADAMTS13 enzyme deficiency. It is often associated with renal failure and neurologic manifestations. TTP requires plasma exchange and we usually use FFP; however, when the blood group is rare we use octaplas®. These patients receive large volumes of plasma; for acute patients they can have plasma exchange for anything from five days up to one month depending on their response. We had an interesting TTP case when a young lady in delivery had preeclampsia.
She had TTP and needed daily plasma exchange for two months. She was AB blood group which is very rare, meaning it was difficult to have sufficient donors to collect enough plasma for her. She was put on 13–15 units of octaplas®. daily for two months. For the past year she has been receiving routine supplementation of octaplas®.
Blood products are involved in so many disciplines of medical practice. It is a dynamic and fast-growing area of medicine. The advances in knowledge that have been made during my 18 years of practice have been tremendous. It is a fascinating field and very important because blood is essential for the wellbeing of everyone.