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Rebulla P, Prati D. Pathogen Reduction for Platelets—A Review of Recent Implementation Strategies. Pathogens 2022; 11:pathogens11020142. [PMID: 35215085 PMCID: PMC8879285 DOI: 10.3390/pathogens11020142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023] Open
Abstract
The development of pathogen reduction technologies (PRT) for labile blood components is a long-pursued goal in transfusion medicine. While PRT for red blood cells and whole blood are still in an early phase of development, different PRT platforms for plasma and platelets are commercially available and routinely used in several countries. This review describes complementary strategies recommended by the US FDA to mitigate the risk of septic reactions in platelet recipients, including PRT and large-volume delayed sampling, and summarizes the main findings of recent reports discussing economical and organizational issues of platelet PRT implementation. Sophisticated mathematical analytical models are available to determine the impact of PRT on platelet costs, shortages and outdates in different settings. PRT implementation requires careful planning to ensure the availability of sufficient economical, technological and human resources. A phased approach was used in most PRT implementation programs, starting with adult and pediatric immunocompromised patients at higher risk of developing septic platelet transfusion reactions. Overall, the reviewed studies show that significant progress has been made in this area, although additional efforts will be necessary to reduce the storage lesion of PRT platelets and to expand the sustainable applicability of PRT to all labile blood components.
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Affiliation(s)
- Paolo Rebulla
- Correspondence: ; Tel.: +39-335-8258625; Fax: +39-(0)2-5458129
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2
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Kracalik I, Mowla S, Basavaraju SV, Sapiano MRP. Transfusion-related adverse reactions: Data from the National Healthcare Safety Network Hemovigilance Module - United States, 2013-2018. Transfusion 2021; 61:1424-1434. [PMID: 33880771 DOI: 10.1111/trf.16362] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/03/2021] [Accepted: 01/23/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite current blood safety measures, transfusion recipients can experience transfusion-related adverse reactions. Monitoring these reactions can aid in understanding the effectiveness of current transfusion safety measures. Data from the National Healthcare Safety Network Hemovigilance Module were used to quantify adverse reaction risk. METHODS Facilities reporting at least one month of transfused blood components and transfusion-related adverse reactions during January 2013-December 2018 were included. Adverse reaction rates (number per 100,000 components transfused) were calculated for transfused components stratified by component type, collection, and modification methods. RESULTS During 2013-2018, 201 facilities reported 18,308 transfusion-related adverse reactions among 8.34 million blood components transfused (220/100,000). Adverse reactions were higher among apheresis (486/100,000) and pathogen-reduced platelets (579/100,000) than apheresis red blood cells (197/100,000). Allergic reactions (41%) were most common. There were 23 fatalities and 9% of all adverse reactions were serious (severe, life-threatening, or fatal). Reactions involving pulmonary complications (transfusion-associated circulatory overload, transfusion-related acute lung injury and transfusion-associated dyspnea) accounted for 35% of serious reactions but 65% of fatalities. Most (76%) of the 37 transfusion-transmitted infections were serious; none involved pathogen-reduced components. CONCLUSIONS One in 455 blood components transfused was associated with an adverse reaction although the risk of serious reactions (1 in 6224) or transfusion-transmitted infections (1 in 225,440) was lower. Some serious reactions identified were preventable, suggesting additional safety measures may be beneficial. Higher reaction rates identified among pathogen-reduced platelets require further study. These findings highlight the importance of monitoring reactions through national hemovigilance to inform current safety measures and the need for strategies to increase healthcare facility participation.
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Affiliation(s)
- Ian Kracalik
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sanjida Mowla
- Oak Ridge Institute for Science and Education (ORISE), Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sridhar V Basavaraju
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Lantana Consulting Group, Inc., East Thetford, Vermont, USA
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Guo K, Wang X, Zhang H, Wang M, Song S, Ma S. Transfusion Reactions in Pediatric Patients: An Analysis of 5 Years of Hemovigilance Data From a National Center for Children's Health in China. Front Pediatr 2021; 9:660297. [PMID: 34123967 PMCID: PMC8193363 DOI: 10.3389/fped.2021.660297] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to describe transfusion reactions of pediatric patients from a National Center for Children's Health in China and to examine reaction incidents, reaction types by blood transfusion, and the associated blood products resulting in transfusion reactions. Methods: We compared transfusion reaction rates, among platelets, plasma, and red blood cells (RBCs) using a retrospective analysis of pediatric patients treated with blood transfusion based on data from the National Center for Children's Health (Beijing, China) by a hemovigilance reporting system from January 2015 to December 2019. Results: Over the past 5 years, 165 reactions were reported, and the overall incidence was 1.35‰ (95% CI: 1.14-1.55‰; 165/122,652); for each separate year, the incidences were 1.25‰ (95% CI: 0.76-1.74‰; 25/20,035; 2015), 1.09‰ (95% CI: 0.65-1.52‰; 24/22,084; 2016), 1.66‰ (95% CI: 1.14-2.18‰; 39/23,483; 2017), 1.36‰ (95% CI: 0.92-1.81‰; 36/26,440; 2018) and 1.34‰ (95% CI: 0.93-1.75‰; 41/30,610; 2019). Transfusion reaction incidents by person included 0.37‰ (95% CI: 0.21-0.53‰; 21/56,815) RBCs, 2.98‰ (95% CI: 2.33-3.64‰; 79/26,496) platelets and 1.65‰ (95% CI: 1.25-2.05‰; 65/39,341) frozen plasma. According to the analysis by blood products, the incidence of transfusion was 0.34‰ (95% CI: 0.20-0.48‰; 23/66,958) for RBCs, 3.21‰ (95% CI: 2.50-3.92‰; 78/24,318.5) for platelets, and 0.94‰ (95% CI: 0.71-1.17‰; 64/67,912) for frozen plasma. Transfusion reactions were most commonly associated with platelets, followed by plasma and RBC transfusions. The types of blood transfusion reactions were mainly allergic reactions (86.67%) and febrile non-hemolytic transfusion reactions (FNHTRs, 4.24%). The disease types of pediatric patients with transfusion reactions were concentrated among those with blood system diseases. A total of 80.61% of children with transfusion reactions had a previous blood transfusion history. Conclusions: Transfusion reactions are still relatively common in pediatric patients, and additional studies are necessary to address the differences in reaction rates, especially allergic and FNHTRs. Robust hemovigilance systems do include a special section dedicated to children will further the understanding of these reactions and trends, and prospective randomized clinical controlled trials may need to be conducted to perform preventive and corrective measures.
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Affiliation(s)
- Kai Guo
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaohuan Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Huimin Zhang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Mengjian Wang
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shanshan Song
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuxuan Ma
- Department of Transfusion Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Haemostatic function measured by thromboelastography and metabolic activity of platelets treated with riboflavin and UV light. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2020; 18:280-289. [PMID: 32530405 DOI: 10.2450/2020.0314-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pathogen reduction technology (PRT) may damage platelet (PLT) components. To study this, metabolic activity and haemostatic function of buffy coat (BC) PLT concentrates, with or without riboflavin and UV light PRT treatment, were compared. MATERIAL AND METHODS Twenty-four BC PLT concentrates, leukoreduced and diluted in additive solution, were grouped into 12 type-matched pairs, which were pooled and divided into 12 non-PRT-treated BC PLT concentrates (control units) and 12 riboflavin and UV PRT-treated BC PLT concentrates (test units). Haemostatic function and metabolic parameters were monitored by thrombelastography at days 1, 3, 7 and 14 post collection in both PLT groups. RESULTS Loss of PLT discoid shape, glucose consumption, lactate production, and decrease in pH were greater in the PRT-treated PLTs than in control PLTs over time (p<0.001). PLT haemostatic function evaluated by clot strength was also significantly weaker in PRT-treated PLTs compared with the excellent clot quality of control PLTs at day 7 (maximum amplitude: 41.27 vs 64.27; p<0.001), and even at day 14 (21.16 vs 60.39; p<0.001) of storage. DISCUSSION Pathogen reduction technology treatment accelerates and increases platelet storage lesion, resulting in glucose depletion, lactate accumulation, PLT acidification, and discoid shape loss. The clots produced by control PLTs at day 14 were still remarkably strong, whereas at day 7 PRT-treated PLTs produced weaker clots compared to the control group. Clinical trials investigating the efficacy of PRT-treated PLTs transfused at the end of the storage period (day 7), when the in vitro clot strength is weaker, are needed.
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Brown BL, McCullough J. Treatment for emerging viruses: Convalescent plasma and COVID-19. Transfus Apher Sci 2020; 59:102790. [PMID: 32345485 PMCID: PMC7194745 DOI: 10.1016/j.transci.2020.102790] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/28/2022]
Abstract
Use of convalescent plasma transfusions could be of great value in the current pandemic of coronavirus disease (COVID-19), given the lack of specific preventative and therapeutic options. This convalescent plasma therapy is of particular interest when a vaccine or specific therapy is not yet available for emerging viruses, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19. This report summarizes existing literature around convalescent plasma as a therapeutic option for COVID-19. It also includes recommendations for establishing a convalescent plasma program, enhancement considerations for convalescent plasma, and considerations around pathogen reduction treatment of convalescent plasma. Time is of the essence to set up protocols for collection, preparation, and administration of apheresis-collected convalescent plasma in response to the current pandemic. The immediate use of convalescent plasma provides prompt availability of a promising treatment while specific vaccines and treatments are evaluated and brought to scale. Further development of improved convalescent plasma, vaccines and other therapeutics depends on quick generation of additional data on pathogenesis and immune response. Additionally, given the lack of information around the natural history of this disease, PRT should be considered to add a layer of safety to protect recipients of convalescent plasma.
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MESH Headings
- Antibodies, Neutralizing/blood
- Antibodies, Neutralizing/therapeutic use
- Antibodies, Viral/blood
- Antibodies, Viral/therapeutic use
- Betacoronavirus/immunology
- Blood Safety
- COVID-19
- Communicable Diseases, Emerging/therapy
- Communicable Diseases, Emerging/virology
- Convalescence
- Coronavirus Infections/blood
- Coronavirus Infections/prevention & control
- Coronavirus Infections/therapy
- Donor Selection
- Humans
- Immunization, Passive
- Meta-Analysis as Topic
- Pandemics/prevention & control
- Plasmapheresis
- Pneumonia, Viral/blood
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/therapy
- SARS-CoV-2
- Severe Acute Respiratory Syndrome/therapy
- United States
- United States Food and Drug Administration
- Virus Inactivation
- COVID-19 Serotherapy
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Contemporary resuscitation of hemorrhagic shock: What will the future hold? Am J Surg 2020; 220:580-588. [PMID: 32409009 PMCID: PMC7211588 DOI: 10.1016/j.amjsurg.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Resuscitation of the critically ill patient with fluid and blood products is one of the most widespread interventions in medicine. This is especially relevant for trauma patients, as hemorrhagic shock remains the most common cause of preventable death after injury. Consequently, the study of the ideal resuscitative product for patients in shock has become an area of great scientific interest and investigation. Recently, the pendulum has swung towards increased utilization of blood products for resuscitation. However, pathogens, immune reactions and the limited availability of this resource remain a challenge for clinicians. Technologic advances in pathogen reduction and innovations in blood product processing will allow us to increase the safety profile and efficacy of blood products, ultimately to the benefit of patients. The purpose of this article is to review the current state of blood product based resuscitative strategies as well as technologic advancements that may lead to safer resuscitation.
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New strategies for the control of infectious and parasitic diseases in blood donors: the impact of pathogen inactivation methods. EUROBIOTECH JOURNAL 2020. [DOI: 10.2478/ebtj-2020-0007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Around 70 infectious agents are possible threats for blood safety.
The risk for blood recipients is increasing because of new emergent agents like West Nile, Zika and Chikungunya viruses, or parasites such as Plasmodium and Trypanosoma cruzi in non-endemic regions, for instance.
Screening programmes of the donors are more and more implemented in several Countries, but these cannot prevent completely infections, especially when they are caused by new agents.
Pathogen inactivation (PI) methods might overcome the limits of the screening and different technologies have been set up in the last years.
This review aims to describe the most widely used methods focusing on their efficacy as well as on the preservation integrity of blood components.
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Jimenez‐Marco T, Garcia‐Recio M, Girona‐Llobera E. Use and safety of riboflavin and UV light‐treated platelet transfusions in children over a five‐year period: focusing on neonates. Transfusion 2019; 59:3580-3588. [DOI: 10.1111/trf.15538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 07/10/2019] [Accepted: 08/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Teresa Jimenez‐Marco
- Fundació Banc de Sang i Teixits de les Illes Balears Majorca Spain
- Grupo de Investigación en Salud Pública de las Illes BalearsInstitut d'Investigació Sanitària Illes Balears (IdISBa) Majorca Spain
| | - Marta Garcia‐Recio
- Hospital Universitari Son Espases Majorca Spain
- Clinica y Biologia de las Neoplasias HematologicasInstitut d'Investigació Sanitària Illes Balears (IdISBa) Majorca Spain
| | - Enrique Girona‐Llobera
- Fundació Banc de Sang i Teixits de les Illes Balears Majorca Spain
- Grupo de Investigación en Salud Pública de las Illes BalearsInstitut d'Investigació Sanitària Illes Balears (IdISBa) Majorca Spain
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9
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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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10
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Cushing MM, Pagano MB, Jacobson J, Schwartz J, Grossman BJ, Kleinman S, Han MA, Cohn CS. Pathogen reduced plasma products: a clinical practice scientific review from the AABB. Transfusion 2019; 59:2974-2988. [DOI: 10.1111/trf.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
| | - Monica B. Pagano
- Department of Laboratory MedicineUniversity of Washington Medical Center Seattle Washington
| | | | - Joseph Schwartz
- Department of Pathology & Cell BiologyColumbia University Vagelos College of Physicians and Surgeons New York New York
| | - Brenda J. Grossman
- Department of Pathology & ImmunologyWashington University School of Medicine in St. Louis St. Louis Missouri
| | - Steven Kleinman
- Department of Pathology & Laboratory MedicineThe University of British Columbia Vancouver British Columbia
| | - Mi Ah Han
- Department of Preventive MedicineCollege of Medicine Chosun University Gwangju Republic of Korea
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
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Kleinman S, Stassinopoulos A. Transfusion-associated graft-versus-host disease reexamined: potential for improved prevention using a universally applied intervention. Transfusion 2018; 58:2545-2563. [DOI: 10.1111/trf.14930] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Steven Kleinman
- Clinical Pathology; University of British Columbia, School of Medicine; Vancouver British Columbia Canada
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12
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Jimenez-Marco T, Garcia-Recio M, Girona-Llobera E. Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care. Transfusion 2018; 58:1881-1889. [DOI: 10.1111/trf.14797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
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13
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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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Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 2018; 36:283-299. [DOI: 10.1200/jco.2017.76.1734] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose To provide evidence-based guidance on the use of platelet transfusion in people with cancer. This guideline updates and replaces the previous ASCO platelet transfusion guideline published initially in 2001. Methods ASCO convened an Expert Panel and conducted a systematic review of the medical literature published from September 1, 2014, through October 26, 2016. This review builds on two 2015 systematic reviews that were conducted by the AABB and the International Collaboration for Transfusion Medicine Guidelines. For clinical questions that were not addressed by the AABB and the International Collaboration for Transfusion Medicine Guidelines (the use of leukoreduction and platelet transfusion in solid tumors or chronic, stable severe thrombocytopenia) or that were addressed partially (invasive procedures), the ASCO search extended back to January 2000. Results The updated ASCO review included 24 more recent publications: three clinical practice guidelines, eight systematic reviews, and 13 observational studies. Recommendations The most substantial change to a previous recommendation involved platelet transfusion in the setting of hematopoietic stem-cell transplantation. Based on data from randomized controlled trials, adult patients who undergo autologous stem-cell transplantation at experienced centers may receive a platelet transfusion at the first sign of bleeding, rather than prophylactically. Prophylactic platelet transfusion at defined platelet count thresholds is still recommended for pediatric patients undergoing autologous stem-cell transplantation and for adult and pediatric patients undergoing allogeneic stem-cell transplantation. Other recommendations address platelet transfusion in patients with hematologic malignancies or solid tumors or in those who undergo invasive procedures. Guidance is also provided regarding the production of platelet products, prevention of Rh alloimmunization, and management of refractoriness to platelet transfusion ( www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki ).
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Affiliation(s)
- Charles A. Schiffer
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Kari Bohlke
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Meghan Delaney
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Heather Hume
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Anthony J. Magdalinski
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Jeffrey J. McCullough
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - James L. Omel
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - John M. Rainey
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Paolo Rebulla
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Scott D. Rowley
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Michael B. Troner
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
| | - Kenneth C. Anderson
- Charles A. Schiffer, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Kari Bohlke, American Society of Clinical Oncology, Alexandria, VA; Meghan Delaney, Children’s National Medical System & George Washington University, Washington DC; Heather Hume, CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada; Anthony J. Magdalinski, Alliance Cancer Specialists, Sellersville, PA; Jeffrey J. McCullough, University of Minnesota, Minneapolis, MN; James L. Omel,
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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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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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Vilariño MD, Castrillo A, Campos A, Kilian R, Villamayor M, Cardoso M. Assessment of the Clinical Performance of Platelet Concentrates Treated by Pathogen Reduction Technology in Santiago de Compostela. Transfus Med Hemother 2017; 44:5-9. [PMID: 28275328 PMCID: PMC5318921 DOI: 10.1159/000447643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study assessed the feasibility, performance, and safety of Mirasol®-treated platelet concentrates (M-PC) stored for up to 7 days. METHODS This prospective observational study was approved by the ethical committee of the University Clinic of Santiago de Compostela. Informed consent was asked from patients receiving M-PC. M-PCs were treated with the Mirasol system according to the manufacturer's instructions. Thrombocytopenic patients were transfused according to the Spanish transfusion guidelines. Post-transfusion platelet counts were measured at 1 h and/or 24 h after transfusion. Post-transfusion surveillance of patients was maintained during the study. RESULTS Data from 54 evaluable patients and 135 transfusions were analyzed. The mean age of patients was 58 years. The mean age of M-PC at transfusion was 3.6 days. The mean platelet dose was 3.7 × 1011. The transfusion responses measured as mean corrected count increment 1 h after transfusion (CCI1h) and CCI24h were 9,659 and 4,751, respectively. 65% of transfusions resulted in CCI1h values ≥ 7,500. 51% of transfusions resulted in CCI24h values ≥ 4,500. CONCLUSION The use of M-PC in the supportive treatment proved to be safe and effective for this cohort of thrombocytopenic patients.
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Affiliation(s)
| | | | - Alfredo Campos
- University Clinic of Santiago de Compostela, Santiago de Compostela, Spain
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Weiskopf RB. What is innovation? Transfusion 2016; 56 Suppl 1:S3-5. [DOI: 10.1111/trf.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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