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Cid J, Charry P, Lozano M. Therapeutic efficacy and safety of pathogen-reduced platelet components: Results of a meta-analysis of randomized controlled trials. Vox Sang 2024; 119:203-211. [PMID: 38181391 DOI: 10.1111/vox.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Clinical efficacy and safety of pathogen-reduced platelet concentrates (PR-PCs) concerning bleeding prevention are still debated despite conclusive real-world data from multiple countries where PR-PCs are transfused routinely. We performed a meta-analysis of randomized controlled trials (RCTs) comparing the clinical efficacy and safety of conventional platelet components (PCs) and PR-PCs prepared with the amotosalen/ultraviolet A light (INTERCEPT platelet concentrate [I-PC]) or riboflavin/ultraviolet light (Mirasol platelet concentrate [M-PC]) technologies, transfused in thrombocytopenic adult patients. MATERIALS AND METHODS A literature search was conducted, and 10 RCTs met the criteria for inclusion in this meta-analysis. Summary odds ratios (ORs) of clinically significant bleeding (World Health Organization [WHO] bleeding grade ≥2), severe bleeding (WHO bleeding score ≥3) and all-cause mortality were calculated. RESULTS The use of I-PC was not associated with an increase in the OR of clinically significant bleeding when compared to non-treated PCs (OR, 1.12; 95% CI: 0.89-1.41; p = 0.33), whereas transfusions with M-PC showed an increase in clinically significant bleeding (OR, 1.34; 95% CI: 1.03-1.75; p = 0.03). The OR of severe bleeding did not increase with either I-PC or M-PC (OR 0.88; 95% CI: 0.59-1.31; p = 0.52 for I-PC; OR 1.25; 95% CI: 0.66-2.37; p = 0.49 for M-PC). In the case of all-cause mortality, compared to non-treated PC, I-PC showed an OR of 0.61 (95% CI: 0.36-1.04; p = 0.07), and M-PC showed an OR of 3.04 (95% CI: 0.81-11.47; p = 0.1). CONCLUSION No differences were observed concerning the clinical efficacy and safety of overall PR-PCs when compared to non-treated PCs. However, differences are evident when analysing platelets prepared with the two PR technologies independently.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Paola Charry
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Koepsell SA, Stolla M, Sedjo RL, Carson J, Knudson M, Cook R, Fasano R, Ngamsuntikul SG, Cohn C, Gorlin J, Delaney M, Slichter S, Ness P, McCullough J. Results of clinical effectiveness of conventional versus Mirasol-treated Apheresis Platelets in Patients with Hypoproliferative Thrombocytopenia (MiPLATE) trial. Transfusion 2024; 64:457-465. [PMID: 38314476 DOI: 10.1111/trf.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND The Mirasol® Pathogen Reduction Technology System was developed to reduce transfusion-transmitted diseases in platelet (PLT) products. STUDY DESIGN AND METHODS MiPLATE trial was a prospective, multicenter, controlled, randomized, non-inferiority (NI) study of the clinical effectiveness of conventional versus Mirasol-treated Apheresis PLTs in participants with hypoproliferative thrombocytopenia. The novel primary endpoint was days of ≥Grade 2 bleeding with an NI margin of 1.6. RESULTS After 330 participants were randomized, a planned interim analysis of 297 participants (145 MIRASOL, 152 CONTROL) receiving ≥1 study transfusion found a 2.79-relative rate (RR) in the MIRASOL compared to the CONTROL in number of days with ≥Grade 2 bleeding (95% confidence interval [CI] 1.67-4.67). The proportion of subjects with ≥Grade 2 bleeding was 40.0% (n = 58) in MIRASOL and 30.3% (n = 46) in CONTROL (RR = 1.32, 95% CI 0.97-1.81, p = .08). Corrected count increments were lower (p < .01) and the number of PLT transfusion episodes per participant was higher (RR = 1.22, 95% CI 1.05-1.41) in MIRASOL. There was no difference in the days of PLT support (hazard ratio = 0.86, 95% CI 0.68-1.08) or total number of red blood cell transfusions (RR = 1.12, 95% CI 0.91-1.37) between MIRASOL versus CONTROL. Transfusion emergent adverse events were reported in 119 MIRASOL participants (84.4%) compared to 133 (82.6%) participants in CONTROL (p = NS). DISCUSSION This study did not support that MIRASOL was non-inferior compared to conventional platelets using the novel endpoint number of days with ≥Grade 2 bleeding in MIRASOL when compared to CONTROL.
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Affiliation(s)
- Scott A Koepsell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Moritz Stolla
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rebecca L Sedjo
- Clinical Research and Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Jeffrey Carson
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael Knudson
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Richard Cook
- Lifetime Scientific Inc., Waterloo, Ontario, Canada
| | - Ross Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathologyand Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Claudia Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jed Gorlin
- Memorial Blood Centers, Minneapolis, Minnesota, USA
| | - Meghan Delaney
- Department of Pathology, Children's National Hospital and The George Washington University School of Medicine, Washington, DC, USA
| | - Sherrill Slichter
- Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington, USA
| | - Paul Ness
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey McCullough
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Rosell-Valle C, Martín-López M, Campos F, Chato-Astrain J, Campos-Cuerva R, Alaminos M, Santos González M. Inactivation of human plasma alters the structure and biomechanical properties of engineered tissues. Front Bioeng Biotechnol 2022; 10:908250. [PMID: 36082161 PMCID: PMC9445835 DOI: 10.3389/fbioe.2022.908250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Fibrin is widely used for tissue engineering applications. The use of blood derivatives, however, carries a high risk of transmission of infectious agents, necessitating the application of pathogen reduction technology (PRT). The impact of this process on the structural and biomechanical properties of the final products is unknown. We used normal plasma (PLc) and plasma inactivated by riboflavin and ultraviolet light exposure (PLi) to manufacture nanostructured cellularized fibrin-agarose hydrogels (NFAHs), and then compared their structural and biomechanical properties. We also measured functional protein C, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and coagulation factors [fibrinogen, Factor (F) V, FVIII, FX, FXI, FXIII] in plasma samples before and after inactivation. The use of PLi to manufacture cellularized NFAHs increased the interfibrillar spacing and modified their biomechanical properties as compared with cellularized NFAH manufactured with PLc. PLi was also associated with a significant reduction in functional protein C, FV, FX, and FXI, and an increase in the international normalized ratio (derived from the PT), APTT, and TT. Our findings demonstrate that the use of PRT for fibrin-agarose bioartificial tissue manufacturing does not adequately preserve the structural and biomechanical properties of the product. Further investigations into PRT-induced changes are warranted to determine the applications of NFAH manufactured with inactivated plasma as a medicinal product.
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Affiliation(s)
- Cristina Rosell-Valle
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
| | - María Martín-López
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Escuela Internacional de Doctorado Universidad de Sevilla, Seville, Spain
| | - Fernando Campos
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Rafael Campos-Cuerva
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Centro de Transfusiones, Tejidos y Células de Sevilla (CTTS), Fundación Pública Andaluza para la Gestión de la Investigación en Salud en Sevilla (FISEVI), Seville, Spain
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Mónica Santos González
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Centro de Transfusiones, Tejidos y Células de Sevilla (CTTS), Fundación Pública Andaluza para la Gestión de la Investigación en Salud en Sevilla (FISEVI), Seville, Spain
- *Correspondence: Mónica Santos González,
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Cancelas JA, Genthe JR, Stolla M, Rugg N, Bailey SL, Nestheide S, Shaz B, Mack S, Schroeder K, Anani W, Szczepiorkowski ZM, Dumont LJ, Yegneswaran S, Corash L, Mufti N, Benjamin RJ, Erickson AC. Evaluation of amotosalen and UVA pathogen-reduced apheresis platelets after 7-day storage. Transfusion 2022; 62:1619-1629. [PMID: 35808974 PMCID: PMC9546462 DOI: 10.1111/trf.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amotosalen/UVA pathogen-reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion-transmitted infections and transfusion-associated graft versus host disease, reduced wastage and improved availability compared with 5-day-stored PCs. This study evaluated the potency of 7-day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs. STUDY DESIGN AND METHODS The in vitro characteristics of 7-day-stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS-3)/35% plasma, thrombin generation, and in vivo radiolabeled post-transfusion recovery and survival of 7-day-stored PRPCs suspended in 100% plasma were compared with either 7-day-stored or fresh autologous conventional platelets. RESULTS PRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7-day PCs. In vivo, the mean post-transfusion survival was 151.4 ± 20.1 h for 7-day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T-ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24-h post-transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T-ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1). DISCUSSION PRPCs collected in both 100% plasma as well as 65% PAS-3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post-radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion.
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Affiliation(s)
| | | | - Moritz Stolla
- Bloodworks Northwest, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Neeta Rugg
- Hoxworth Blood Center, Cincinnati, Ohio, USA
| | | | | | - Beth Shaz
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Zbigniew M Szczepiorkowski
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | - Nina Mufti
- Cerus Corporation, Concord, California, USA
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Schepici G, Gugliandolo A, Mazzon E. Serum-Free Cultures: Could They Be a Future Direction to Improve Neuronal Differentiation of Mesenchymal Stromal Cells? Int J Mol Sci 2022; 23:ijms23126391. [PMID: 35742836 PMCID: PMC9223839 DOI: 10.3390/ijms23126391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023] Open
Abstract
Mesenchymal stem/stromal cells (MSCs) are undifferentiated cells with multilinear potential, known for their immunomodulatory and regenerative properties. Although the scientific community is working to improve their application, concerns limit their use to repair tissues following neurological damage. One of these obstacles is represented by the use of culture media supplemented with fetal bovine serum (FBS), which, due to its xenogenic nature and the risk of contamination, has increased scientific, ethical and safety problems. Therefore, the use of serum-free media could improve MSC culture methods, avoiding infectious and immunogenic transmission problems as well as MSC bioprocesses, without the use of animal components. The purpose of our review is to provide an overview of experimental studies that demonstrate that serum-free cultures, along with the supplementation of growth factors or chemicals, can lead to a more defined and controlled environment, enhancing the proliferation and neuronal differentiation of MSCs.
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6
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Pati I, Masiello F, Pupella S, Cruciani M, De Angelis V. Efficacy and Safety of Pathogen-Reduced Platelets Compared with Standard Apheresis Platelets: A Systematic Review of RCTs. Pathogens 2022; 11:pathogens11060639. [PMID: 35745493 PMCID: PMC9231062 DOI: 10.3390/pathogens11060639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
In this systematic review, we evaluate the efficacy and safety of blood components treated with pathogen reduction technologies (PRTs). We searched the Medline, Embase, Scopus, Ovid, and Cochrane Library to identify RCTs evaluating PRTs. Risk of bias assessment and the Mantel–Haenszel method for data synthesis were used. We included in this review 19 RCTs evaluating 4332 patients (mostly oncohematological patients) receiving blood components treated with three different PRTs. Compared with standard platelets (St-PLTs), the treatment with pathogen-reduced platelets (PR-PLTs) does not increase the occurrence of bleeding events, although a slight increase in the occurrence of severe bleeding events was observed in the overall comparison. No between-groups difference in the occurrence of serious adverse events was observed. PR-PLT recipients had a lower 1 and 24 h CI and CCI. The number of patients with platelet refractoriness and alloimmunization was significantly higher in PR-PLT recipients compared with St-PLT recipients. PR-PLT recipients had a higher number of platelet and RBC transfusions compared with St-PLT recipients, with a shorter transfusion time interval. The quality of evidence for these outcomes was from moderate to high. Blood components treated with PRTs are not implicated in serious adverse events, and PR-PLTs do not have a major effect on the increase in bleeding events. However, treatment with PRTs may require a greater number of transfusions in shorter time intervals and may be implicated in an increase in platelet refractoriness and alloimmunization.
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7
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Li M, Irsch J, Corash L, Benjamin RJ. Is pathogen reduction an acceptable alternative to irradiation for risk mitigation of transfusion-associated graft versus host disease? Transfus Apher Sci 2022; 61:103404. [DOI: 10.1016/j.transci.2022.103404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Rosell-Valle C, Martín-López M, Campos F, Chato-Astrain J, Campos-Cuerva R, Alaminos M, Santos González M. Inactivation of human plasma alters the structure and biomechanical properties of engineered tissues. Front Bioeng Biotechnol 2022. [PMID: 36082161 DOI: 10.3389/fbioe.2022.908250/full] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Fibrin is widely used for tissue engineering applications. The use of blood derivatives, however, carries a high risk of transmission of infectious agents, necessitating the application of pathogen reduction technology (PRT). The impact of this process on the structural and biomechanical properties of the final products is unknown. We used normal plasma (PLc) and plasma inactivated by riboflavin and ultraviolet light exposure (PLi) to manufacture nanostructured cellularized fibrin-agarose hydrogels (NFAHs), and then compared their structural and biomechanical properties. We also measured functional protein C, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and coagulation factors [fibrinogen, Factor (F) V, FVIII, FX, FXI, FXIII] in plasma samples before and after inactivation. The use of PLi to manufacture cellularized NFAHs increased the interfibrillar spacing and modified their biomechanical properties as compared with cellularized NFAH manufactured with PLc. PLi was also associated with a significant reduction in functional protein C, FV, FX, and FXI, and an increase in the international normalized ratio (derived from the PT), APTT, and TT. Our findings demonstrate that the use of PRT for fibrin-agarose bioartificial tissue manufacturing does not adequately preserve the structural and biomechanical properties of the product. Further investigations into PRT-induced changes are warranted to determine the applications of NFAH manufactured with inactivated plasma as a medicinal product.
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Affiliation(s)
- Cristina Rosell-Valle
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
| | - María Martín-López
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Escuela Internacional de Doctorado Universidad de Sevilla, Seville, Spain
| | - Fernando Campos
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Jesús Chato-Astrain
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Rafael Campos-Cuerva
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Centro de Transfusiones, Tejidos y Células de Sevilla (CTTS), Fundación Pública Andaluza para la Gestión de la Investigación en Salud en Sevilla (FISEVI), Seville, Spain
| | - Miguel Alaminos
- Tissue Engineering Group, Department of Histology, Universidad de Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. Granada, Granada, Spain
| | - Mónica Santos González
- Unidad de Producción y Reprogramación Celular de Sevilla (UPRC), Red Andaluza de Diseño y Traslación de Terapias Avanzadas (RADyTTA), Seville, Spain
- Centro de Transfusiones, Tejidos y Células de Sevilla (CTTS), Fundación Pública Andaluza para la Gestión de la Investigación en Salud en Sevilla (FISEVI), Seville, Spain
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9
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Escolar G, Diaz-Ricart M, McCullough J. Impact of different pathogen reduction technologies on the biochemistry, function, and clinical effectiveness of platelet concentrates: An updated view during a pandemic. Transfusion 2021; 62:227-246. [PMID: 34870335 PMCID: PMC9300014 DOI: 10.1111/trf.16747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/03/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022]
Abstract
Standard platelet concentrates (PCs) stored at 22°C have a limited shelf life of 5 days. Because of the storage temperature, bacterial contamination of PCs can result in life‐threatening infections in transfused patients. The potential of blood components to cause infections through contaminating pathogens or transmitting blood‐borne diseases has always been a concern. The current safety practice to prevent pathogen transmission through blood transfusion starts with a stringent screening of donors and regulated testing of blood samples to ensure that known infections cannot reach transfusion products. Pathogen reduction technologies (PRTs), initially implemented to ensure the safety of plasma products, have been adapted to treat platelet products. In addition to reducing bacterial contamination, PRT applied to PCs can extend their shelf life up to 7 days, alleviating the impact of their shortage, while providing an additional safety layer against emerging blood‐borne infectious diseases. While a deleterious action of PRTs in quantitative and qualitative aspects of plasma is accepted, the impact of PRTs on the quality, function, and clinical efficacy of PCs has been under constant examination. The potential of PRTs to prevent the possibility of new emerging diseases to reach cellular blood components has been considered more hypothetical than real. In 2019, a coronavirus‐related disease (COVID‐19) became a pandemic. This episode should help when reconsidering the possibility of future blood transmissible threats. The following text intends to evaluate the impact of different PRTs on the quality, function, and clinical effectiveness of platelets within the perspective of a developing pandemic.
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Affiliation(s)
- Gines Escolar
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
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10
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Lasky B, Nolasco J, Graff J, Ward DC, Ziman A, McGonigle AM. Pathogen-reduced platelets in pediatric and neonatal patients: Demographics, transfusion rates, and transfusion reactions. Transfusion 2021; 61:2869-2876. [PMID: 34448199 DOI: 10.1111/trf.16639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pathogen-reduced platelets (PR PLT) are the emerging standard for proactive transfusion-transmitted infection (TTI) mitigation. There is, however, continued hesitation to transfuse PR PLT in children due to limited published data. We report demographics, rates of transfusion, and transfusion reactions (TR) associated with FDA-approved PR PLT in pediatric and neonatal patients at an academic medical center. METHODS Retrospective review was performed for patients <18 years receiving at least one platelet over a 300-day period at a large, tertiary care hospital. Patients were transfused PR or conventional (CONV) PLT, based on inventory availability. Statistical analysis was performed using Fisher Exact Test. RESULTS During the study period, 191 patients received 1010 platelet transfusions (892 units). Sixty-eight patients received PR PLT only (1.3 units/patient, 95% confidence interval [CI] 1.1-1.5; 1.8 transfusions/patient, 95% CI 1.4-2.2), and 56 patients received CONV PLT only (1.4 units/patient, 95% CI 1.1-1.7; 1.6 transfusions/patient, 95% CI 1.3-1.9). Patients with hematologic malignancies undergoing chemotherapy/radiation and allogeneic hematopoietic stem cell transplant received the most platelet transfusions and more commonly received both platelet types. Of 506 PR PLT units, 5 TRs occurred; 386 CONV PLT resulted in two TRs (p = .7052). Of 51 neonates, 37 received PR PLT without adverse events, including 13 receiving phototherapy. No TTIs were identified in any group. CONCLUSION There was no significant difference in rates of transfusion or TRs between PR and CONV PLT. Our study provides additional evidence that PR PLT can be transfused to pediatric and neonatal patients without increasing the risk of acute adverse events.
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Affiliation(s)
- Baia Lasky
- Division of Biomedical Services, American Red Cross, Biomedical Services, Washington, District of Columbia, USA
| | - Joseph Nolasco
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Jazmin Graff
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Dawn C Ward
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Alyssa Ziman
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Andrea M McGonigle
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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11
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Earnshaw S, Beyhaghi H, McDade C, Purser M, Marriott R, Daane L, Le Coent V, Yang J, Toback S. Clinical and economic impacts of large volume delayed sampling and pathogen reduction technology platelet processing strategies in the United States. Transfusion 2021; 61:2885-2897. [PMID: 34289101 DOI: 10.1111/trf.16589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Large volume delayed sampling (LVDS) and pathogen reduction technology (PRT) are strategies for platelet processing to minimize transfusion of contaminated platelet components (PCs). This study holistically compares the economic and clinical impact of LVDS and PRT in the United States. STUDY DESIGN AND METHODS A decision model was constructed to simulate collection, processing, and use of PCs and to compare processing strategies: PRT with 5-day shelf life, LVDS with 7-day shelf life (LVDS7), and LVDS with 5-day shelf life extended to 7 days with secondary testing (LVDS5/2). Target population was adults requiring two or more transfusions. Collection, processing, storage, and distribution data were obtained from the National Blood Collection and Utilization Survey and published literature. Patient outcomes associated with transfusions were obtained from AABB guidelines, meta-analyses, and other published clinical studies. Costs were obtained from reimbursement schedules and other published sources. RESULTS Given 10,000 donated units, 9512, 9511, and 9651 units of PRT, LVDS5/2, and LVDS7 PCs were available for transfusion, respectively. With these units, 1502, 2172, and 2329 transfusions can be performed with similar levels of adverse events. Assuming 30 transfusions a day, a hospital would require 69,325, 47,940, and 45,383 units of PRT, LVDS5/2, and LVDS7 platelets to perform these transfusions. The mean costs to perform transfusions were significantly higher with PRT units. CONCLUSIONS Compared with PRT, LVDS strategies were associated with lower costs and higher PC availability while patients experienced similar levels of adverse events. Increased utilization of LVDS has the potential to improve efficiency, expand patient access to platelets, and reduce health care costs.
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Affiliation(s)
- Stephanie Earnshaw
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Hadi Beyhaghi
- Medical Affairs, Novavax Inc, Gaithersburg, Maryland, USA
| | - Cheryl McDade
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Molly Purser
- Value Evidence and Outcomes, GlaxoSmithKline LLC, Upper Providence, Pennsylvania, USA
| | - Robert Marriott
- Laboratory Operations Consulting, Marriott Quality and Performance Solutions LLC, Raleigh, NC, USA
| | - Lori Daane
- Industry Healthcare Division, bioMérieux, Inc., Chicago, Illinois, USA
| | | | - Julie Yang
- Industry Healthcare Division, bioMérieux, Inc., Chicago, Illinois, USA
| | - Seth Toback
- Medical Affairs, Novavax Inc, Gaithersburg, Maryland, USA
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12
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Abstract
Bacterial contamination of blood components is a recurrent topic in transfusion medicine community. This issue is even more important with platelet transfusions because of storage of platelet components at room temperature for 5 days. Pathogen inactivation methods are a proactive approach to deal with an infectious agent. All available methods use UV light, with or without a photosensitizer, to inactivate potential pathogens. As with other medical interventions, pathogen inactivation methods carry benefits and risks. Among benefits, inactivation of known and unknown transfusion-transmitted pathogens, inactivation of residual leukocytes, and increased storage length from 5 to 7 days are the most interesting. The main risk is the impact on clinical efficacy of pathogen-reduced platelets. After inactivation, pathogen-reduced platelets are associated with a lower number of platelets in the final product, lower 24-hour corrected count increment, and shorter transfusion interval when compared with non-inactivated platelets. However, eight of nine randomized controlled trials showed that transfusing pathogen-reduced platelets were not inferior to transfusing usual platelet components in the prevention of bleeding episodes. In conclusion, in our opinion, increasing safety of platelet transfusions with pathogen inactivation methods is worthy, even the trade-off of causing damage to platelets.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
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13
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Brixner V, Bug G, Pohler P, Krämer D, Metzner B, Voss A, Casper J, Ritter U, Klein S, Alakel N, Peceny R, Derigs HG, Stegelmann F, Wolf M, Schrezenmeier H, Thiele T, Seifried E, Kapels HH, Döscher A, Petershofen EK, Müller TH, Seltsam A. Efficacy of UVC-treated, pathogen-reduced platelets versus untreated platelets: a randomized controlled non-inferiority trial. Haematologica 2021; 106:1086-1096. [PMID: 33538149 PMCID: PMC8018132 DOI: 10.3324/haematol.2020.260430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Pathogen reduction (PR) technologies for blood components have been established to reduce the residual risk of known and emerging infectious agents. THERAFLEX UV-Platelets, a novel ultraviolet C (UVC) light-based PR technology for platelet concentrates, works without photoactive substances. This randomized, controlled, double-blind, multicenter, non-inferiority trial was designed to compare the efficacy and safety of UVC-treated platelets to that of untreated platelets in thrombocytopenic patients with hematologic-oncologic diseases. The primary objective was to determine non-inferiority of UVC-treated platelets, assessed by the 1-hour corrected count increment (CCI) in up to eight per-protocol platelet transfusion episodes. Analysis of the 171 eligible patients showed that the defined non-inferiority margin of 30% of UVC-treated platelets was narrowly missed as the mean differences in 1-hour CCI between standard platelets versus UVC-treated platelets for intention-to-treat and per-protocol analyses were 18.2% (95% Confidence Interval [CI]: 6.4-30.1) and 18.7% (95% CI: 6.3-31.1), respectively. In comparison to the control, the UVC group had a 19.2% lower mean 24-hour CCI and was treated with an about 25% higher number of platelet units, but the average number of days to the next platelet transfusion did not differ significantly between both treatment groups. The frequency of low-grade adverse events was slightly higher in the UVC group and the frequencies of refractoriness to platelet transfusion, platelet alloimmunization, severe bleeding events, and red blood cell transfusions were comparable between groups. Our study suggests that transfusion of pathogen-reduced platelets produced with the UVC technology is safe but non-inferiority was not demonstrated. (clinicaltrials gov. Identifier: DRKS00011156).
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Affiliation(s)
- Veronika Brixner
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | - Gesine Bug
- Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main
| | | | - Doris Krämer
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Bernd Metzner
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Andreas Voss
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Jochen Casper
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Ulrich Ritter
- Department of Hematology and Oncology, Municipal Hospital Bremen, Bremen
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital, Mannheim
| | - Nael Alakel
- Medical Clinic I, Department of Hematology and Oncology, University Hospital, Carl Gustav Carus Faculty of Medicine, Dresden
| | - Rudolf Peceny
- Department of Hematology and Oncology, Municipal Hospital, Osnabrück
| | - Hans G Derigs
- Department of Hematology and Oncology, Municipal Hospital Frankfurt-Hoechst, Frankfurt/Main
| | | | - Martin Wolf
- Department of Hematology and Oncology, Municipal Hospital, Kassel
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg - Hessia, Ulm
| | - Thomas Thiele
- Institute for Immunology and Transfusion Medicine, University Medicine, Greifswald
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | | | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany; Bavarian Red Cross Blood Service, Nuremberg.
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14
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McCullough J. Pathogen Reduced Blood Products. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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15
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Abe H, Endo K, Nogawa M, Shiba M, Miyata S, Satake M. In vitro thrombus formation and in vivo hemostasis mediated by platelets irradiated with bactericidal ultraviolet C from xenon flash under flow conditions. Transfusion 2020; 61:191-201. [PMID: 33107611 DOI: 10.1111/trf.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a flow path-ultraviolet C (UVC) irradiation system for platelet concentrates (PCs) with platelet additive solution (PAS) to minimize contamination by bacteria. Here, we investigated functionalities of irradiated platelets (PLTs) in in vitro thrombus formation and in vivo hemostasis. STUDY DESIGN AND METHODS PAS-PCs were irradiated with flash UVC using the flow path system. Their variables (PLT count, mean platelet volume, pH, glucose, lactate, glycoprotein [GP] Ib, and activated integrin αIIbβ3) were evaluated. Static adhesion to collagen or fibrinogen was analyzed using fluorescent microscopy. Thrombus formation under flow conditions was assessed using a collagen-coated bead column. Adenosine diphosphate (ADP)-induced Akt phosphorylation was determined by western blot. In vivo hemostasis and circulatory survival of PLTs were assessed with a rabbit bleeding model. RESULTS All variables, except for GPIb expression, were slightly, but significantly, impaired after flash UVC irradiation throughout the 6-day storage period. No difference was observed in static adhesion to either collagen or fibrinogen between irradiated and nonirradiated PAS-PCs. In vitro thrombus formation of flash UVC-irradiated PAS-PCs was significantly greater than that of nonirradiated PAS-PCs. ADP-induced Akt phosphorylation was enhanced in irradiated PAS-PCs. In vivo hemostatic efficacy was comparable between the groups on Day 1. The efficacy declined in nonirradiated PAS-PCs on Day 5, while it was retained in flash UVC-irradiated PAS-PCs. Circulatory survival of PLTs was lower in irradiated PAS-PCs. CONCLUSIONS PAS-PCs irradiated with UVC from xenon flash have favorable properties to achieve hemostasis compared with nonirradiated PAS-PCs.
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Affiliation(s)
- Hideki Abe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kimika Endo
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masayuki Nogawa
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.,Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Shiba
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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16
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Heddle NM, Cardoso M, Meer PF. Revisiting study design and methodology for pathogen reduced platelet transfusions: a round table discussion. Transfusion 2020; 60:1604-1611. [DOI: 10.1111/trf.15779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/20/2020] [Accepted: 02/15/2020] [Indexed: 01/28/2023]
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17
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Rebulla P, Garban F, Meer PF, Heddle NM, McCullough J. A crosswalk tabular review on methods and outcomes from randomized clinical trials using pathogen reduced platelets. Transfusion 2020; 60:1267-1277. [DOI: 10.1111/trf.15791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and HematologyFoundation IRCCS Caʼ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Frederic Garban
- Department of HaematologyCentre Hospitalier Universitaire de Grenoble Alpes Grenoble France
| | - Pieter F. Meer
- Department of Product and Process DevelopmentSanquin Blood Bank Amsterdam The Netherlands
| | - Nancy M. Heddle
- Department of MedicineMcMaster University Hamilton Ontario Canada
| | - Jeffrey McCullough
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota USA
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18
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Newland A, Bentley R, Jakubowska A, Liebman H, Lorens J, Peck-Radosavljevic M, Taieb V, Takami A, Tateishi R, Younossi ZM. A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia. ACTA ACUST UNITED AC 2020; 24:679-719. [PMID: 31581933 DOI: 10.1080/16078454.2019.1662200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.
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Affiliation(s)
- Adrian Newland
- Barts Health National Health Service (NHS) Trust , London , UK
| | | | | | - Howard Liebman
- Jane Anne Nohl Division of Hematology, USC Norris Cancer Hospital , Los Angeles , CA , USA
| | | | - Markus Peck-Radosavljevic
- Department of Gastroenterology & Hepatology, Endocrinology and Nephrology, Klinikum Klagenfurt , Klagenfurt , Austria.,Division of Gastroenterology & Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna , Austria
| | | | - Akiyoshi Takami
- Department of Internal Medicine, Division of Hematology, Aichi Medical University School of Medicine , Nagakute , Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo , Tokyo , Japan
| | - Zobair M Younossi
- Department of Medicine, Inova Fairfax Hospital , Falls Church , VA , USA
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19
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Diallo I, Benmoussa A, Laugier J, Osman A, Hitzler WE, Provost P. Platelet Pathogen Reduction Technologies Alter the MicroRNA Profile of Platelet-Derived Microparticles. Front Cardiovasc Med 2020; 7:31. [PMID: 32266291 PMCID: PMC7096552 DOI: 10.3389/fcvm.2020.00031] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
Despite improvements in donor screening and increasing efforts to avoid contamination and the spread of pathogens in clinical platelet concentrates (PCs), the risks of transfusion-transmitted infections remain important. Relying on an ultraviolet photo activation system, pathogen reduction technologies (PRTs), such as Intercept and Mirasol, utilize amotosalen, and riboflavin (vitamin B2), respectively, to mediate inactivation of pathogen nucleic acids. Although they are expected to increase the safety and prolong the shelf life of clinical PCs, these PRTs might affect the quality and function of platelets, as recently reported. Upon activation, platelets release microparticles (MPs), which are involved in intercellular communications and regulation of gene expression, thereby mediating critical cellular functions. Here, we have used small RNA sequencing (RNA-Seq) to document the effect of PRT treatment on the microRNA profiles of platelets and derived MPs. PRT treatment did not affect the microRNA profile of platelets. However, we observed a specific loading of certain microRNAs into platelet MPs, which was impaired by treatment with Intercept or its Additive solution (SSP+). Whereas, Intercept had an impact on the microRNA profile of platelet-derived MPs, Mirasol did not impact the microRNA profile of platelets and derived MPs, compared to non-treated control. Considering that platelet MPs are able to transfer their microRNA content to recipient cells, and that this content may exert biological activities, those findings suggest that PRT treatment of clinical PCs may modify the bioactivity of the platelets and MPs to be transfused and argue for further investigations into PRT-induced changes in clinical PC content and function.
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Affiliation(s)
- Idrissa Diallo
- Research Center of the CHU de Québec, Quebec, QC, Canada.,Department of Microbiology-Infectious Disease and Immunity, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Abderrahim Benmoussa
- Research Center of the CHU de Québec, Quebec, QC, Canada.,Department of Microbiology-Infectious Disease and Immunity, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Jonathan Laugier
- Research Center of the CHU de Québec, Quebec, QC, Canada.,Department of Microbiology-Infectious Disease and Immunity, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Abdimajid Osman
- Department of Clinical Chemistry, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Walter E Hitzler
- Transfusion Center, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Patrick Provost
- Research Center of the CHU de Québec, Quebec, QC, Canada.,Department of Microbiology-Infectious Disease and Immunity, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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20
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Jóhannsson F, Árnason NÁ, Landrö R, Guðmundsson S, Sigurjonsson ÓE, Rolfsson Ó. Metabolomics study of platelet concentrates photochemically treated with amotosalen and UVA light for pathogen inactivation. Transfusion 2019; 60:367-377. [PMID: 31802514 DOI: 10.1111/trf.15610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The risk of bacterial contamination and the deterioration of platelet (PLT) quality limit the shelf-life of platelet concentrates (PCs). The INTERCEPT pathogen inactivation system reduces the risk of pathogen transmission by inhibiting nucleic acid replication using a combination of a photo-reactive compound and UVA illumination. The goal of this study was to investigate the effects the INTERCEPT system has on the PLT metabolome and metabolic activity. STUDY DESIGN AND METHODS Paired units of buffy coat-derived PCs were generated using a pool and split strategy (n = 8). The paired PCs were either treated with the INTERCEPT system or left untreated. Samples were collected on Days 1, 2, 4, and 7 of storage. Ultra-performance chromatography coupled with time-of-flight mass spectrometry was used to analyze the extra- and intracellular metabolomes. Constraint-based metabolic modeling was then used to predict the metabolic activity of the stored PLTs. RESULTS A relatively large number of metabolites in the extracellular environment were depleted during the processing steps of the INTERCEPT system, in particular, metabolites with hydrophobic functional groups, including acylcarnitines and lysophosphatidylcholines. In the intracellular environment, alterations in glucose and glycerophospholipid metabolism and decreased levels of 2-hydroxyglutarate were observed following the INTERCEPT treatment. Untargeted metabolomics analysis revealed residual amotosalen dimers present in the treated PCs. Systems-level analysis of PLT metabolism indicated that the INTERCEPT system does not have a significant impact on the PLT energy metabolism and nutrient utilization. CONCLUSIONS The INTERCEPT system significantly alters the metabolome of the stored PCs without significantly influencing PLT energy metabolism.
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Affiliation(s)
- Freyr Jóhannsson
- Center for Systems Biology, University of Iceland, Sturlugata 8, Reykjavik, Iceland.,Medical Department, University of Iceland, Sturlugata 8, Reykjavik, Iceland
| | - Níels Á Árnason
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Ragna Landrö
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Sveinn Guðmundsson
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Ólafur E Sigurjonsson
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland.,School of Science and Engineering, Reykjavik University, Menntavegur 1, Reykjavik, Iceland
| | - Óttar Rolfsson
- Center for Systems Biology, University of Iceland, Sturlugata 8, Reykjavik, Iceland.,Medical Department, University of Iceland, Sturlugata 8, Reykjavik, Iceland
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21
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Infanti L, Holbro A, Passweg J, Bolliger D, Tsakiris DA, Merki R, Plattner A, Tappe D, Irsch J, Lin J, Corash L, Benjamin RJ, Buser A. Clinical impact of amotosalen-ultraviolet A pathogen-inactivated platelets stored for up to 7 days. Transfusion 2019; 59:3350-3361. [PMID: 31574181 PMCID: PMC6900102 DOI: 10.1111/trf.15511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Universal pathogen inactivation of platelet concentrates (PCs) using amotosalen/ultraviolet A with 7-day storage was implemented in Switzerland in 2011. Routine-use data were analyzed at the University Hospital Basel, Switzerland. STUDY DESIGN A retrospective two-cohort study of patient and PC characteristics, component usage, patient outcomes, count increments (CIs), and adverse events were analyzed for two consecutive 5-year periods with either 0- to 5-day-old conventional PC (C-PC) (n = 14,181) or 0- to 7-day-old pathogen-inactivated PC (PI-PC) (n = 22,579). RESULTS In both periods, PCs were issued for transfusion on a "first in, first out" basis. With 7-day PI-PC, wastage was reduced from 8.7% to 1.5%; 16.6% of transfused PI-PCs were more than 5 days old. Transfusion of PI-PC more than 5 days old compared with 5 days old or less did not increase platelet and RBC use on the same or next day as an indirect measure of hemostasis and did not increase transfusion reactions. Mean corrected count increments (CCIs) for PI-PC stored for 5 days or less were 22.6% lower than for C-PC (p < 0.001), and declined with increasing storage duration for both, although the correlation was weak (r2 = 0.005-0.014). Mean number of PCs used per patient and duration of PC support were not different for hematology/oncology, allogeneic and autologous hematopoietic stem cell transplant (HSCT), and general medical/surgical patients, who used the majority (~92.0%) of PI-PCs. Five-year treatment-related mortality in allogeneic HSCT was unchanged in the PI-PC period. CONCLUSIONS PI-PCs with 7-day storage reduced wastage and did not increase PC or red blood cell utilization or adverse reactions compared with fresh PI-PC or a historical control group, demonstrating preserved efficacy and safety.
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Affiliation(s)
- Laura Infanti
- Regional Blood Transfusion ServiceSwiss Red CrossBaselSwitzerland
| | - Andreas Holbro
- Regional Blood Transfusion ServiceSwiss Red CrossBaselSwitzerland
- HematologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Jakob Passweg
- HematologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Daniel Bolliger
- Department for Anesthesia, Prehospital Emergency Medicine, and Pain TherapyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | | | - Ramona Merki
- HematologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | | | | | | | | | | | | | - Andreas Buser
- Regional Blood Transfusion ServiceSwiss Red CrossBaselSwitzerland
- HematologyUniversity Hospital Basel, University of BaselBaselSwitzerland
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22
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Rebulla P. The long and winding road to pathogen reduction of platelets, red blood cells and whole blood. Br J Haematol 2019; 186:655-667. [PMID: 31304588 DOI: 10.1111/bjh.16093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion-transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens' nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre-clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion-transmissible infections.
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Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and Haematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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23
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Karakatsanis SJ, Papadatos SS, Syrigos KN. Hypoplastic thrombocytopenia and platelet transfusion: therapeutic goals. Hosp Pract (1995) 2019; 47:16-23. [PMID: 30409035 DOI: 10.1080/21548331.2019.1546530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/07/2018] [Indexed: 06/08/2023]
Abstract
Platelet transfusions consist a major part of the management of hypoplastic thrombocytopenia, the latter occurring mainly among patients with hematological malignancies. Platelet transfusions have led to a reduction of deaths attributable to thrombocytopenia-induced bleeding, despite their possible complications; nonetheless, prophylactic administration of platelets to patients with severe thrombocytopenia or before invasive procedures should be based on specific criteria, as well as therapeutic administration during active bleeding. Recently developed ex-vivo procedures have resulted in producing safer blood products, yet it remains unclear whether these pathogen-inactivated products have sufficient efficacy. What is more, another significant problem that remains to be more effectively addressed is the developing refractoriness to platelet transfusions.
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Affiliation(s)
- Stamatis J Karakatsanis
- a Faculty of Medicine, Hematology Unit, 3rd Department of Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Stamatis S Papadatos
- b Faculty of Medicine, Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
| | - Konstantinos N Syrigos
- c Faculty of Medicine, 3rd Department of Internal Medicine , National and Kapodistrian University of Athens , Athens , Greece
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24
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Benjamin RJ, Katz L, Gammon RR, Stramer SL, Quinley E. The argument(s) for lowering the US minimum required content of apheresis platelet components. Transfusion 2018; 59:779-788. [PMID: 30461026 PMCID: PMC7379583 DOI: 10.1111/trf.15036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 12/16/2022]
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25
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Lotens A, de Valensart N, Najdovski T, Acquart S, Cognasse F, Rapaille A. Influence of platelet preparation techniques on in vitro storage quality after psoralen-based photochemical treatment using new processing sets for triple-dose units. Transfusion 2018; 58:2942-2951. [PMID: 30362131 DOI: 10.1111/trf.14909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The INTERCEPT Blood System (IBS) for platelets (PLTs) uses a combination of psoralen and ultraviolet-A light to inactivate pathogens that may contaminate PLT concentrates (PCs). However, no data are available on the quality of IBS-treated PLTs from different apheresis and buffy-coat PC preparation platforms using the new triple storage (TS) set. STUDY DESIGN AND METHODS The objective of this study was to evaluate the TS set on three different preparation platforms compared with the large-volume (LV) set, as control. PLT in vitro metabolic and activation parameters were studied over 7 days. RESULTS Several statistical differences are observed between the two sets, particularly for pH, oxygen pressure (pO2 ), carbonic gaz pressure (pCO2 ), and bicarbonate. The three different preparation techniques influence PLT parameters, and the difference is statistically significant for all the studied parameters, except for pCO2 . The TS set has the advantage of shorter compound adsorption device time, higher PLT recoveries, and less PLT activation. CONCLUSION Results from the measured metabolic parameters and PLT variables obtained from PCs treated by LV and TS sets indicated good PLT function preservation up to 7 days of storage. The in vitro assessment results demonstrated acceptable PLT function for transfusion.
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Affiliation(s)
- Anaïs Lotens
- Service du Sang, Belgian Red Cross, Namur, Belgium
| | | | | | | | - Fabrice Cognasse
- Etablissement Français du Sang, Saint-Etienne, France.,Université de Lyon, GIMAP-EA3064, Saint-Etienne, France
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Stivala S, Gobbato S, Infanti L, Reiner MF, Bonetti N, Meyer SC, Camici GG, Lüscher TF, Buser A, Beer JH. In response to the comment by Hechler et al.: Amotosalen/UVA pathogen inactivation technology reduces platelet activatability, induces apoptosis and accelerates clearance. Haematologica 2018; 102:e504-e505. [PMID: 29192132 DOI: 10.3324/haematol.2017.181818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Simona Stivala
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Sara Gobbato
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Laura Infanti
- Regional Service of the Swiss Red Cross, University Hospital Basel, Switzerland
| | | | - Nicole Bonetti
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Sara C Meyer
- Hematology, University Hospital Basel, Switzerland
| | - Giovanni G Camici
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Thomas F Lüscher
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Andreas Buser
- Regional Service of the Swiss Red Cross, University Hospital Basel, Switzerland
| | - Juerg H Beer
- Laboratory for Platelet Research, Center for Molecular Cardiology, University of Zurich, Switzerland .,Internal Medicine, Cantonal Hospital of Baden, Switzerland
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Waters L, Cameron M, Padula MP, Marks DC, Johnson L. Refrigeration, cryopreservation and pathogen inactivation: an updated perspective on platelet storage conditions. Vox Sang 2018; 113:317-328. [PMID: 29441601 DOI: 10.1111/vox.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Conventional storage of platelet concentrates limits their shelf life to between 5 and 7 days due to the risk of bacterial proliferation and the development of the platelet storage lesion. Cold storage and cryopreservation of platelets may facilitate extension of the shelf life to weeks and years, and may also provide the benefit of being more haemostatically effective than conventionally stored platelets. Further, treatment of platelet concentrates with pathogen inactivation systems reduces bacterial contamination and provides a safeguard against the risk of emerging and re-emerging pathogens. While each of these alternative storage techniques is gaining traction individually, little work has been done to examine the effect of combining treatments in an effort to further improve product safety and minimize wastage. This review aims to discuss the benefits of alternative storage techniques and how they may be combined to alleviate the problems associated with conventional platelet storage.
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Affiliation(s)
- L Waters
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M Cameron
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - D C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - L Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
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Rebulla P, Milani S, Grazzini G. Response to "An unbalanced study that lacks power: a caution about IPTAS". Transfusion 2017; 57:2285-2287. [PMID: 28868737 DOI: 10.1111/trf.14210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/19/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Paolo Rebulla
- Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Silvano Milani
- Laboratory of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, University of Milan, Milan
| | - Giuliano Grazzini
- Italian National Blood Center, National Institute of Health, Rome, Italy
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Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2017; 7:CD009072. [PMID: 28756627 PMCID: PMC5558872 DOI: 10.1002/14651858.cd009072.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets.This is an update of a Cochrane review first published in 2013. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. SELECTION CRITERIA We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another.Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials).One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other participants were thrombocytopenic individuals who had a haematological or oncological diagnosis. Eight trials included only adults.Four of the included studies were at low risk of bias in every domain, while the remaining eight included studies had some threats to validity.Overall, the quality of the evidence was low to high across different outcomes according to GRADE methodology.We are very uncertain as to whether pathogen-reduced platelets increase the risk of any bleeding (World Health Organization (WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio (RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I2 = 59%, random-effect RR 1.14, 95% CI 0.93 to 1.38; I2 = 59%; low-quality evidence).There was no evidence of a difference between pathogen-reduced platelets and standard platelets in the incidence of clinically significant bleeding complications (WHO Grade 2 or higher) (5 trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I2 = 0%; moderate-quality evidence), and there is probably no difference in the risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495 participants; RR 1.24, 95% CI 0.76 to 2.02; I2 = 32%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR 0.81, 95% CI 0.50 to 1.29; I2 = 26%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of serious adverse events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35; I2 = 0%; moderate-quality evidence). However, no bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Participants who received pathogen-reduced platelet transfusions had an increased risk of developing platelet refractoriness (7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I2 = 0%; high-quality evidence), though the definition of platelet refractoriness differed between trials.Participants who received pathogen-reduced platelet transfusions required more platelet transfusions (6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to 1.61; I2 = 27%; high-quality evidence), and there was probably a shorter time interval between transfusions (6 trials, 1489 participants; MD -0.42, 95% CI -0.53 to -0.32; I2 = 29%; moderate-quality evidence). Participants who received pathogen-reduced platelet transfusions had a lower 24-hour corrected-count increment (7 trials, 1681 participants; MD -3.02, 95% CI -3.57 to -2.48; I2 = 15%; high-quality evidence).None of the studies reported quality of life.We did not evaluate any economic outcomes.There was evidence of subgroup differences in multiple transfusion trials between the two pathogen-reduced platelet technologies assessed in this review (Intercept® and Mirasol®) for all-cause mortality and the interval between platelet transfusions (favouring Intercept®). AUTHORS' CONCLUSIONS Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or severe bleeding, or the risk of a serious adverse event. There was insufficient evidence for people with other diagnoses.All three ongoing trials are in adults (planned recruitment 1375 participants) with a haematological or oncological diagnosis.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
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Hess JR, Pagano MB, Barbeau JD, Johannson PI. Will pathogen reduction of blood components harm more people than it helps in developed countries? Transfusion 2017; 56:1236-41. [PMID: 27167359 DOI: 10.1111/trf.13512] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/24/2015] [Accepted: 12/31/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Blood-borne infectious diseases are a major impediment to the provision of safe blood. Pathogen reduction (PR) technologies have been approved for the treatment of plasma and platelet (PLT) concentrates to reduce infectious complications and graft-versus-host disease but product potency is adversely affected STUDY DESIGN AND METHODS We reviewed published data describing PR technology for estimates of treated blood component physical and functional loss. These physical and functional losses were summed and projected onto measured effects of plasma and PLT dose in trauma resuscitation. The net benefits estimated as reduced infectious disease deaths were compared to net losses estimated as increased deaths from uncontrolled hemorrhage. RESULTS Transfusion-transmitted infectious diseases caused five or fewer acute deaths each year from 2009 through 2014 in the United States according to the Food and Drug Administration. In-hospital deaths from uncontrolled hemorrhage after trauma number more than 10,000 yearly and are reduced by 4% to 15% with concentrated blood product resuscitation. The loss of 20% of plasma potency and 30% of PLT potency to PR is likely to be associated with 400 extra trauma deaths each year. Trauma represents a small fraction, perhaps 15%, of all massively transfused individuals. CONCLUSIONS Resuscitation of massive hemorrhage may be limited by blood component potency as shown in our literature review and analysis. The safety-versus-potency trade involved with current blood plasma and PLT PR technology is likely to result in a net loss of life. Hemorrhagic risk from reduced blood product potency for patients with trauma and other indications for massive transfusion is an important consideration in risk-based decision making for implementing PR.
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Affiliation(s)
- John R Hess
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
| | - James D Barbeau
- Department of Pathology, Brown University School of Medicine, Providence, Rhode Island
| | - Pär I Johannson
- Department of Transfusion Medicine, Rigshospitalet, Copenhagen, Denmark.,Department of Surgery, University of Texas Health Medical School, Houston, Texas
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31
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Magron A, Laugier J, Provost P, Boilard E. Pathogen reduction technologies: The pros and cons for platelet transfusion. Platelets 2017; 29:2-8. [PMID: 28523956 DOI: 10.1080/09537104.2017.1306046] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The transfusion of platelets is essential for diverse pathological conditions associated with thrombocytopenia or platelet disorders. To maintain optimal platelet quality and functions, platelets are stored as platelet concentrates (PCs) at room temperature under continuous agitation-conditions that are permissive for microbial proliferation. In order to reduce these contaminants, pathogen reduction technologies (PRTs) were developed by the pharmaceutical industry and subsequently implemented by blood banks. PRTs rely on chemically induced cross-linking and inactivation of nucleic acids. These technologies were initially introduced for the treatment of plasma and, more recently, for PCs given the absence of a nucleus in platelets. Several studies verified the effectiveness of PRTs to inactivate a broad array of bacteria, viruses, and parasites. However, the safety of PRT-treated platelets has been questioned in other studies, which focused on the impact of PRTs on platelet quality and functions. In this article, we review the literature regarding PRTs, and present the advantages and disadvantages related to their application in platelet transfusion medicine.
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Affiliation(s)
- Audrey Magron
- a Centre de Recherche du Centre Hospitalier Universitaire de Québec , Faculté de Médecine de l'Université Laval, Département de Microbiologie et Immunologie , Québec , QC , Canada
| | - Jonathan Laugier
- a Centre de Recherche du Centre Hospitalier Universitaire de Québec , Faculté de Médecine de l'Université Laval, Département de Microbiologie et Immunologie , Québec , QC , Canada
| | - Patrick Provost
- a Centre de Recherche du Centre Hospitalier Universitaire de Québec , Faculté de Médecine de l'Université Laval, Département de Microbiologie et Immunologie , Québec , QC , Canada
| | - Eric Boilard
- a Centre de Recherche du Centre Hospitalier Universitaire de Québec , Faculté de Médecine de l'Université Laval, Département de Microbiologie et Immunologie , Québec , QC , Canada
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Rebulla P, Vaglio S, Beccaria F, Bonfichi M, Carella A, Chiurazzi F, Coluzzi S, Cortelezzi A, Gandini G, Girelli G, Graf M, Isernia P, Marano G, Marconi M, Montemezzi R, Olivero B, Rinaldi M, Salvaneschi L, Scarpato N, Strada P, Milani S, Grazzini G. Clinical effectiveness of platelets in additive solution treated with two commercial pathogen-reduction technologies. Transfusion 2017; 57:1171-1183. [DOI: 10.1111/trf.14042] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Paolo Rebulla
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Stefania Vaglio
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Francesco Beccaria
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Maurizio Bonfichi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Angelo Carella
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Federico Chiurazzi
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Serelina Coluzzi
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Agostino Cortelezzi
- Hematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan; Milan Italy
| | - Giorgio Gandini
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Gabriella Girelli
- Blood Transfusion Service and Hematology; Umberto I Hospital; Rome Italy
| | - Maria Graf
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paola Isernia
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Giuseppe Marano
- Italian National Blood Center, National Institute of Health; Rome Italy
| | - Maurizio Marconi
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Rachele Montemezzi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Barbara Olivero
- Blood Transfusion Service, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - Marianna Rinaldi
- Blood Transfusion Service and Hematology; University Hospital; Verona Italy
| | - Laura Salvaneschi
- Blood Transfusion Service and Hematology; IRCCS Policlinico San Matteo; Pavia Italy
| | - Nicola Scarpato
- Blood Transfusion Service and Hematology; Federico II University Hospital; Naples Italy
| | - Paolo Strada
- Blood Transfusion Service and Hematology 1; IRCCS San Martino University Hospital; Genoa Italy
| | - Silvano Milani
- Laboratory of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Giuliano Grazzini
- Italian National Blood Center, National Institute of Health; Rome Italy
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Abstract
Platelet transfusions continue to be the mainstay to treat patients with quantitative and qualitative platelet disorders. Each year, about 10 millions of platelet transfusions are administered to patients worldwide with marked differences in usage between regions depending on socioeconomic development of the countries. Unfortunately, its use is associated to immune and non-immune side effects. Among the non-immune, bacterial contamination is still the major infectious risk. When bacterial culture methods are introduced for preventing bacterial septic reactions it has been found that this strategy reduce to one half the septic reactions, but do not eliminate completely that risk. To remove completely the risk, a new bacteria detection test at the time of issuance in the case of platelets stored for four or five days would be needed. Pathogen inactivation (PI) methods already in the market (based in the addition of amotosalen (A-L) or riboflavin (R-L) and the illumination with ultraviolet light) or under development (ultraviolet light C and agitation) have shown to be efficacious in the inactivation of bacteria and no cases of septic reactions associated to a pathogen-reduced product has been identified. However, it has been shown that PI technologies have measurable effects on platelet in vitro parameters and reduce the recovery and survival of treated platelets in vivo. Although these effects do not hamper the hemostatic capacity of treated platelets, an increased usage associated with PI technologies has been reported. This increase in utilization seems to be the toll to be paid if we want to completely eliminate the risk of bacterial sepsis in the recipients of platelet transfusion.
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Osman A, Hitzler WE, Provost P. Peculiarities of studying the effects of pathogen reduction technologies on platelets. Proteomics Clin Appl 2016; 10:805-15. [PMID: 27095411 DOI: 10.1002/prca.201500124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/27/2016] [Accepted: 04/14/2016] [Indexed: 12/31/2022]
Abstract
The transfusion of platelet concentrates (PCs) is mainly used for treatment of thrombocytopenic, trauma or surgery patients. The integrity and safety of these platelet preparations, however, is compromised by the presence of pathogens, such as viruses, bacteria and parasites. The transfer of allogeneic donor leukocytes contaminating PCs can also potentially cause adverse reactions in recipients. These considerations prompted the development and implementation of pathogen reduction technologies (PRT), which are based on chemically induced cross-linking and inactivation of nucleic acids. While the incumbent PRT may provide some protection against transfusion-transmitted infections, they are ineffective against infectious prions and may not inactivate other emerging pathogens. In addition, the safety of PRT concerning platelet viability and function has been questioned in several reports. Recent studies suggest that PRT, such as Intercept, may adversely affect the messenger RNA (mRNA) and microRNA content of platelets, as well as their functional integrity, which may compromise the clinical benefits of PRT. Here, we will discuss about the peculiarities of studying the effects of PRT on platelets, which will need to be taken into account in future studies aimed to characterize further, and polish, the rugged side of this otherwise useful and potentially important approach in transfusion medicine.
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Affiliation(s)
- Abdimajid Osman
- Department of Clinical Chemistry, Region Östergötland, Linköping, Sweden.,Department of Clinical and Experimental Medicine, University of Linköping, Linköping, Sweden
| | - Walter E Hitzler
- Transfusion Center, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Patrick Provost
- CHUQ Research Center/CHUL, Quebec, QC, Canada.,Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Knutson F, Osselaer J, Pierelli L, Lozano M, Cid J, Tardivel R, Garraud O, Hervig T, Domanovic D, Cukjati M, Gudmundson S, Hjalmarsdottir IB, Castrillo A, Gonzalez R, Brihante D, Santos M, Schlenke P, Elliott A, Lin JS, Tappe D, Stassinopoulos A, Green J, Corash L. A prospective, active haemovigilance study with combined cohort analysis of 19,175 transfusions of platelet components prepared with amotosalen-UVA photochemical treatment. Vox Sang 2015; 109:343-52. [PMID: 25981525 PMCID: PMC4690512 DOI: 10.1111/vox.12287] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A photochemical treatment process (PCT) utilizing amotosalen and UVA light (INTERCEPT(™) Blood System) has been developed for inactivation of viruses, bacteria, parasites and leucocytes that can contaminate blood components intended for transfusion. The objective of this study was to further characterize the safety profile of INTERCEPT-treated platelet components (PCT-PLT) administered across a broad patient population. MATERIALS AND METHODS This open-label, observational haemovigilance programme of PCT-PLT transfusions was conducted in 21 centres in 11 countries. All transfusions were monitored for adverse events within 24 h post-transfusion and for serious adverse events (SAEs) up to 7 days post-transfusion. All adverse events were assessed for severity (Grade 0-4), and causal relationship to PCT-PLT transfusion. RESULTS Over the course of 7 years in the study centres, 4067 patients received 19,175 PCT-PLT transfusions. Adverse events were infrequent, and most were of Grade 1 severity. On a per-transfusion basis, 123 (0.6%) were classified an acute transfusion reaction (ATR) defined as an adverse event related to the transfusion. Among these ATRs, the most common were chills (77, 0.4%) and urticaria (41, 0.2%). Fourteen SAEs were reported, of which 2 were attributed to platelet transfusion (<0.1%). No case of transfusion-related acute lung injury, transfusion-associated graft-versus-host disease, transfusion-transmitted infection or death was attributed to the transfusion of PCT-PLT. CONCLUSION This longitudinal haemovigilance safety programme to monitor PCT-PLT transfusions demonstrated a low rate of ATRs, and a safety profile consistent with that previously reported for conventional platelet components.
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Affiliation(s)
- F Knutson
- Department of Immunology, Genetics, and Pathology, Uppsala University, Uppsala, Sweden
| | - J Osselaer
- Cliniques Universitaires de Mont Godinne, Universite Catholique de Louvain, Yvoir, Belgium
| | - L Pierelli
- Department of Experimental Medicine, Sapienza University of Roma, Rome, Italy
| | - M Lozano
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - J Cid
- Department of Hemotherapy and Hemostasis, CDB, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | | | - O Garraud
- EFS Auvergne Loire, St. Etienne, France
| | - T Hervig
- Department of Immunology and Transfusion Medicine, University of Bergen, Bergen, Norway
| | - D Domanovic
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - M Cukjati
- Blood Transfusion Centre of Slovenia, Ljubljana, Slovenia
| | - S Gudmundson
- Blood Bank, National University Hospital, Reykjavik, Iceland
| | | | - A Castrillo
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - R Gonzalez
- Transfusion Centre of Galicia, Santiago de Compostela, Spain
| | - D Brihante
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - M Santos
- Servico de Imuno-Hemoterapia, Instituto Portugues de Oncologia de Lisboa, Lisbon, Portugal
| | - P Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - J-S Lin
- Cerus Corporation, Concord, CA, USA
| | - D Tappe
- Cerus Corporation, Concord, CA, USA
| | | | - J Green
- Cerus Corporation, Concord, CA, USA
| | - L Corash
- Cerus Corporation, Concord, CA, USA
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Abonnenc M, Sonego G, Crettaz D, Aliotta A, Prudent M, Tissot JD, Lion N. In vitro study of platelet function confirms the contribution of the ultraviolet B (UVB) radiation in the lesions observed in riboflavin/UVB-treated platelet concentrates. Transfusion 2015; 55:2219-30. [DOI: 10.1111/trf.13123] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 02/24/2015] [Accepted: 02/28/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Mélanie Abonnenc
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - Giona Sonego
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - David Crettaz
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - Alessandro Aliotta
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - Michel Prudent
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - Jean-Daniel Tissot
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
| | - Niels Lion
- Laboratoire de Recherche sur les Produits Sanguins Epalinges; Transfusion Interrégionale CRS; Epalinges Switzerland
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Salunkhe V, van der Meer PF, de Korte D, Seghatchian J, Gutiérrez L. Development of blood transfusion product pathogen reduction treatments: A review of methods, current applications and demands. Transfus Apher Sci 2015; 52:19-34. [DOI: 10.1016/j.transci.2014.12.016] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sandgren P, Diedrich B. Pathogen inactivation of double-dose buffy-coat platelet concentrates photochemically treated with amotosalen and UVA light: preservation ofin vitrofunction. Vox Sang 2014; 108:340-9. [DOI: 10.1111/vox.12232] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/16/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023]
Affiliation(s)
- P. Sandgren
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
| | - B. Diedrich
- Department of Clinical Immunology and Transfusion Medicine; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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Kaiser-Guignard J, Canellini G, Lion N, Abonnenc M, Osselaer JC, Tissot JD. The clinical and biological impact of new pathogen inactivation technologies on platelet concentrates. Blood Rev 2014; 28:235-41. [PMID: 25192602 DOI: 10.1016/j.blre.2014.07.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/14/2014] [Indexed: 01/01/2023]
Abstract
Since 1990, several techniques have been developed to photochemically inactivate pathogens in platelet concentrates, potentially leading to safer transfusion therapy. The three most common methods are amotosalen/UVA (INTERCEPT Blood System), riboflavin/UVA-UVB (MIRASOL PRT), and UVC (Theraflex-UV). We review the biology of pathogen inactivation methods, present their efficacy in reducing pathogens, discuss their impact on the functional aspects of treated platelets, and review clinical studies showing the clinical efficiency of the pathogen inactivation methods and their possible toxicity.
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Affiliation(s)
| | - Giorgia Canellini
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Niels Lion
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Mélanie Abonnenc
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Jean-Claude Osselaer
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
| | - Jean-Daniel Tissot
- Service régional vaudois de transfusion, Route de la Corniche 2, 1066 Epalinges, Switzerland.
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40
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Schlenke P. Pathogen inactivation technologies for cellular blood components: an update. Transfus Med Hemother 2014; 41:309-25. [PMID: 25254027 PMCID: PMC4164100 DOI: 10.1159/000365646] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/27/2014] [Indexed: 01/19/2023] Open
Abstract
Nowadays patients receiving blood components are exposed to much less transfusion-transmitted infectious diseases than three decades before when among others HIV was identified as causative agent for the acquired immunodeficiency syndrome and the transmission by blood or coagulation factors became evident. Since that time the implementation of measures for risk prevention and safety precaution was socially and politically accepted. Currently emerging pathogens like arboviruses and the well-known bacterial contamination of platelet concentrates still remain major concerns of blood safety with important clinical consequences, but very rarely with fatal outcome for the blood recipient. In contrast to the well-established pathogen inactivation strategies for fresh frozen plasma using the solvent-detergent procedure or methylene blue and visible light, the bench-to-bedside translation of novel pathogen inactivation technologies for cell-containing blood components such as platelets and red blood cells are still underway. This review summarizes the pharmacological/toxicological assessment and the inactivation efficacy against viruses, bacteria, and protozoa of each of the currently available pathogen inactivation technologies and highlights the impact of the results obtained from several randomized clinical trials and hemovigilance data. Until now in some European countries pathogen inactivation technologies are in in routine use for single-donor plasma and platelets. The invention and adaption of pathogen inactivation technologies for red blood cell units and whole blood donations suggest the universal applicability of these technologies and foster a paradigm shift in the manufacturing of safe blood.
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Affiliation(s)
- Peter Schlenke
- Department for Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria
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41
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Prudent M, Sonego G, Abonnenc M, Tissot JD, Lion N. LC-MS/MS analysis and comparison of oxidative damages on peptides induced by pathogen reduction technologies for platelets. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2014; 25:651-661. [PMID: 24470194 DOI: 10.1007/s13361-013-0813-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/21/2013] [Accepted: 12/13/2013] [Indexed: 06/03/2023]
Abstract
Pathogen reduction technologies (PRT) are photochemical processes that use a combination of photosensitizers and UV-light to inactivate pathogens in platelet concentrates (PCs), a blood-derived product used to prevent hemorrhage. However, different studies have questioned the impact of PRT on platelet function and transfusion efficacy, and several proteomic analyses revealed possible oxidative damages to proteins. The present work focused on the oxidative damages produced by the two main PRT on peptides. Model peptides containing residues prone to oxidation (tyrosine, histidine, tryptophane, and cysteine) were irradiated with a combination of amotosalen/UVA (Intercept process) or riboflavin/UVB (Mirasol-like process). Modifications were identified and quantified by liquid chromatography coupled to tandem mass spectrometry. Cysteine-containing peptides formed disulfide bridges (R-SS-R, -2 Da; favored following amotosalen/UVA), sulfenic and sulfonic acids (R-SOH, +16 Da, R-SO3H, +48 Da, favored following riboflavin/UVB) upon treatment and the other amino acids exhibited different oxidations revealed by mass shifts from +4 to +34 Da involving different mechanisms; no photoadducts were detected. These amino acids were not equally affected by the PRT and the combination riboflavin/UVB generated more oxidation than amotosalen/UVA. This work identifies the different types and sites of peptide oxidations under the photochemical treatments and demonstrates that the two PRT may behave differently. The potential impact on proteins and platelet functions may thus be PRT-dependent.
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Affiliation(s)
- Michel Prudent
- Service Régional Vaudois de Transfusion Sanguine, Unité de Recherche et Développement, Lausanne, Switzerland
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42
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Prudent M, D’Alessandro A, Cazenave JP, Devine DV, Gachet C, Greinacher A, Lion N, Schubert P, Steil L, Thiele T, Tissot JD, Völker U, Zolla L. Proteome Changes in Platelets After Pathogen Inactivation—An Interlaboratory Consensus. Transfus Med Rev 2014; 28:72-83. [DOI: 10.1016/j.tmrv.2014.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 12/21/2022]
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Hechler B, Ohlmann P, Chafey P, Ravanat C, Eckly A, Maurer E, Mangin P, Isola H, Cazenave JP, Gachet C. Preserved functional and biochemical characteristics of platelet components prepared with amotosalen and ultraviolet A for pathogen inactivation. Transfusion 2013; 53:1187-200. [PMID: 23067365 DOI: 10.1111/j.1537-2995.2012.03923.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 07/23/2012] [Accepted: 08/15/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Platelet concentrate (PC) functionality decreases during storage. This is referred to as the storage lesion. Pathogen inactivation may accelerate or induce lesions, potentially accounting for reduced viability. Our aim was to characterize functional and biochemical properties of platelets (PLTs) from photochemically treated buffy-coat PCs (PCT-PCs) compared to those from conventional PCs. STUDY DESIGN AND METHODS Four PCT-PCs and four conventional PCs were stored for 6.5 days and PLT function and proteomic profiles were examined at various time points during storage. To evaluate their intrinsic properties, samples of stored PLTs were taken, washed, and suspended in Tyrode's buffer before testing. RESULTS PLT counts and morphology were conserved although a slight increase in the PLT volume was observed after PCT. Glycoprotein (GP) IIbIIIa, IaIIa, and VI expression remained stable while GPIbα declined similarly in both types of PCs. A steep decrease (50%) in GPV occurred on Day 1.5 in PCT-PCs and Day 2.5 in control PCs. For both PCT- and control PCs, P-selectin expression and activated GPIIbIIIa remained low during storage. PCT- and control PCs were fully responsive to aggregation agonists up to Day 4.5 and exhibited similar perfusion functionality. Mitochondrial membrane potential and annexin A5 binding of PCT-PCs and control PCs were comparable. Two-dimensional differential in-gel electrophoresis and mass spectrometry profiles for 1882 protein spots revealed only three proteins selectively changed in PCT-PCs compared to control-PCs. CONCLUSION Washed treated and untreated PCs have similar functional, morphologic, and proteomic characteristics provided that PLTs are suspended in an appropriate medium during testing.
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Affiliation(s)
- Béatrice Hechler
- INSERM, UMR_S949, Université de Strasbourg, Etablissement Français du Sang-Alsace (EFS-Alsace), Strasbourg, France
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Seltsam A, Müller TH. Update on the use of pathogen-reduced human plasma and platelet concentrates. Br J Haematol 2013; 162:442-54. [PMID: 23710899 DOI: 10.1111/bjh.12403] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of pathogen reduction technologies (PRTs) for labile blood components is slowly but steadily increasing. While pathogen-reduced plasma is already used routinely, efficacy and safety concerns impede the widespread use of pathogen-reduced platelets. The supportive and often prophylactic nature of blood component therapy in a variety of clinical situations complicates the clinical evaluation of these novel blood products. However, an increasing body of evidence on the clinical efficacy, safety, cost-benefit ratio and development of novel technologies suggests that pathogen reduction has entered a stage of maturity that could further increase the safety margin in haemotherapy. This review summarizes the clinical evidence on PRTs for plasma and platelet products that are currently licensed or under development.
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Affiliation(s)
- Axel Seltsam
- Institute Springe, German Red Cross Blood Service NSTOB, Springe, Germany.
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Lozano M, Cid J. Analysis of reasons for not implementing pathogen inactivation for platelet concentrates. Transfus Clin Biol 2013; 20:158-64. [DOI: 10.1016/j.tracli.2013.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Cook RJ, Lee KA, Cuerden M, Cotton CA. Inverse probability weighted estimating equations for randomized trials in transfusion medicine. Stat Med 2013; 32:4380-99. [PMID: 23625873 DOI: 10.1002/sim.5827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 03/26/2013] [Indexed: 11/11/2022]
Abstract
Thrombocytopenia is a condition characterized by extremely low platelet counts, which puts patients at elevated risk of morbidity and mortality because of bleeding. Trials in transfusion medicine are routinely designed to assess the effect of experimental platelet products on patients' platelet counts. In such trials, patients may receive multiple platelet transfusions over a predefined period of treatment, and a response is available from each such administration. The resulting data comprised multiple responses per patient, and although it is natural to want to use this data in testing for treatment effects, naive analyses of the multiple responses can yield biased estimates of the probability of response and associated treatment effects. These biases arise because only subsets of the patients randomized contribute response data on the second and subsequent administrations of therapy and the balance between treatment groups with respect to potential confounding factors is lost. We discuss the design and analysis issues involved in this setting and make recommendations for the design of future platelet transfusion trials.
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Affiliation(s)
- Richard J Cook
- Department of Statistics and Actuarial Science, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada N2L 3G1
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Butler C, Doree C, Estcourt LJ, Trivella M, Hopewell S, Brunskill SJ, Stanworth S, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2013:CD009072. [PMID: 23543569 DOI: 10.1002/14651858.cd009072.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in patients who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections (TTIs) for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce further the risk of TTIs from platelet transfusion is photochemical pathogen reduction, a process by which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven significantly to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet recovery and the prevention of bleeding when compared with standard platelets. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in patients requiring platelet transfusions. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library 2013, Issue 1), MEDLINE (1950 to 18 February 2013), EMBASE (1980 to 18 February 2013), CINAHL (1982 to 18 February 2013) and the Transfusion Evidence Library (1980 to 18 February 2013). We also searched several international and ongoing trial databases and citation-tracked relevant reference lists. We requested information on possible unpublished trials from known investigators in the field. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing the transfusion of pathogen-reduced platelets with standard platelets. We did not identify any RCTs which compared the transfusion of one type of pathogen-reduced platelets with another. DATA COLLECTION AND ANALYSIS One author screened all references, excluding duplicates and those clearly irrelevant. Two authors then screened the remaining references, confirmed eligibility, extracted data and analysed trial quality independently. We requested and obtained a significant amount of missing data from trial authors. We performed meta-analyses where appropriate using the fixed-effect model for risk ratios (RR) or mean differences (MD), with 95% confidence intervals (95% CI), and used the I² statistic to explore heterogeneity, employing the random-effects model when I² was greater than 30%. MAIN RESULTS We included 10 trials comparing pathogen-reduced platelets with standard platelets. Nine trials assessed Intercept® pathogen-reduced platelets and one trial Mirasol® pathogen-reduced platelets. Two were randomised cross-over trials and the remaining eight were parallel-group RCTs. In total, 1422 participants were available for analysis across the 10 trials, of which 675 participants received Intercept® and 56 Mirasol® platelet transfusions. Four trials assessed the response to a single study platelet transfusion (all Intercept®) and six to multiple study transfusions (Intercept® (N = 5), Mirasol® (N = 1)) compared with standard platelets.We found the trials to be generally at low risk of bias but heterogeneous regarding the nature of the interventions (platelet preparation), protocols for platelet transfusion, definitions of outcomes, methods of outcome assessment and duration of follow-up.Our primary outcomes were mortality, 'any bleeding', 'clinically significant bleeding' and 'severe bleeding', and were grouped by duration of follow-up: short (up to 48 hours), medium (48 hours to seven days) or long (more than seven days). Meta-analysis of data from five trials of multiple platelet transfusions reporting 'any bleeding' over a long follow-up period found an increase in bleeding in those receiving pathogen-reduced platelets compared with standard platelets using the fixed-effect model (RR 1.09, 95% CI 1.02 to 1.15, I² = 59%); however, this meta-analysis showed no difference between treatment arms when using the random-effects model (RR 1.14, 95% CI 0.93 to 1.38).There was no evidence of a difference between treatment arms in the number of patients with 'clinically significant bleeding' (reported by four out of the same five trials) or 'severe bleeding' (reported by all five trials) (respectively, RR 1.06, 95% CI 0.93 to 1.21, I² = 2%; RR 1.27, 95% CI 0.76 to 2.12, I² = 51%). We also found no evidence of a difference between treatment arms for all-cause mortality, acute transfusion reactions, adverse events, serious adverse events and red cell transfusion requirements in the trials which reported on these outcomes. No bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Although the definition of platelet refractoriness differed between trials, the relative risk of this event was 2.74 higher following pathogen-reduced platelet transfusion (RR 2.74, 95% CI 1.84 to 4.07, I² = 0%). Participants required 7% more platelet transfusions following pathogen-reduced platelet transfusion when compared with standard platelet transfusion (MD 0.07, 95% CI 0.03 to 0.11, I² = 21%), although the interval between platelet transfusions was only shown to be significantly shorter following multiple Intercept® pathogen-reduced platelet transfusion when compared with standard platelet transfusion (MD -0.51, 95% CI -0.66 to -0.37, I² = 0%). In trials of multiple pathogen-reduced platelets, our analyses showed the one- and 24-hour count and corrected count increments to be significantly inferior to standard platelets. However, one-hour increments were similar in trials of single platelet transfusions, although the 24-hour count and corrected count increments were again significantly lower. AUTHORS' CONCLUSIONS We found no evidence of a difference in mortality, 'clinically significant' or 'severe bleeding', transfusion reactions or adverse events between pathogen-reduced and standard platelets. For a range of laboratory outcomes the results indicated evidence of some benefits for standard platelets over pathogen-reduced platelets. These conclusions are based on data from 1422 patients included in 10 trials. Results from ongoing or new trials are required to determine if there are clinically important differences in bleeding risk between pathogen-reduced platelet transfusions and standard platelet transfusions. Given the variability in trial design, bleeding assessment and quality of outcome reporting, it is recommended that future trials apply standardised approaches to outcome assessment and follow-up, including safety reporting.
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Affiliation(s)
- Caroline Butler
- Haematology Department, Oxford Radcliffe Hospital NHS Trust, Maidenhead, UK
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48
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Current methods for the reduction of blood-borne pathogens: a comprehensive literature review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:343-8. [PMID: 23522896 DOI: 10.2450/2013.0218-12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 12/06/2012] [Indexed: 11/21/2022]
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49
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Estcourt LJ, Heddle N, Kaufman R, McCullough J, Murphy MF, Slichter S, Wood EM, Stanworth SJ. The challenges of measuring bleeding outcomes in clinical trials of platelet transfusions. Transfusion 2013; 53:1531-43. [DOI: 10.1111/trf.12058] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/17/2012] [Accepted: 08/22/2012] [Indexed: 11/30/2022]
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50
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Sigle JP, Infanti L, Studt JD, Martinez M, Stern M, Gratwohl A, Passweg J, Tichelli A, Buser AS. Comparison of transfusion efficacy of amotosalen-based pathogen-reduced platelet components and gamma-irradiated platelet components. Transfusion 2012; 53:1788-97. [DOI: 10.1111/j.1537-2995.2012.03959.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 09/20/2012] [Accepted: 09/25/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Joerg-Peter Sigle
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Laura Infanti
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Jan-Dirk Studt
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Maria Martinez
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Martin Stern
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Alois Gratwohl
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Jakob Passweg
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - André Tichelli
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
| | - Andreas S. Buser
- Blood Transfusion Center Swiss Red Cross; Hematology, Department of Internal Medicine; University Hospital Basel; Basel; Switzerland
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