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Cheng Z, Kong Y, Lin Y, Mi Z, Xiao L, Liu Z, Tian L. Transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion: A systematic review and meta-analysis. Transfus Apher Sci 2024; 63:103943. [PMID: 38820943 DOI: 10.1016/j.transci.2024.103943] [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: 01/05/2024] [Revised: 04/25/2024] [Accepted: 05/07/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND ABO-nonidentical platelets transfusion has been frequently employed to address clinical platelets insufficiencies. The significance of ABO compatibility for platelets transfusion is not clearly defined. This study is aimed to explore the transfusion outcomes and clinical safety of ABO-nonidentical platelets transfusion. STUDY DESIGN AND METHODS A systematic articles search was performed for eligible studies published up to November 30, 2023 through the PubMed, Embase, Cochrane library, Chinese National Knowledge Infrastructure database, Wanfang database and SinMed. Meta-analysis Of Observational Studies in Epidemiology study guidelines for observational studies and Newcastle Ottawa bias scale were implemented to assess studies. Meta-analysis was performed using Manager 5.3. This study is registered with PROSPERO, number CRD42023417824. RESULTS A total of 11 retrospective cohort studies and 7 prospective cohort studies with a sample size of 104,359 platelets transfusions were included. There was significant difference in transfusion effectiveness between the ABO-identical and ABO-nonidentical platelets transfusions (RR 1.20, 95 % CI 1.11-1.38, P < 0.00001, I2 = 21 %), also the ABO-identical platelets transfusions showed more platelets increment than ABO-nonidentical ones, but it was not statistically significant (MD 0.34, 95 % CI - 0.01 to 0.70, P = 0.06, I2 = 0 %). Allergy and fever occurred more in ABO-nonidentical platelets transfusions in terms of adverse reactions (RR 0.63, 95 % CI 0.41-0.96, P = 0.03, I2 = 0 %; RR 0.59, 95 % CI 0.37-0.94, P = 0.03, I2 = 31 %). When it comes to the mortality, the ABO-identical platelets transfusions did not statistically improve survival in patients who received multiple platelets transfusions (RR 0.77, 95 % CI 0.72-0.83, P = 0.17, I2 = 38 %) and who only received less than 3 transfusions (RR 0.74, 95 % CI 0.52-1.06, P = 0.10, I2 = 47 %) compared with the ABO-nonidentical platelets transfusions. CONCLUSION In comparison to ABO-identical platelets transfusions, nonidentical platelets transfusions exhibited lower transfusion efficacy. However, the clinical safety between these two groups was similar, which indicated that ABO-nonidentical transfusions are acceptable, albeit inferior to ABO-identical ones.
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Affiliation(s)
- Zhanrui Cheng
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Yujie Kong
- Department of Laboratory, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan 610599, China; School of Clinical Medicine, Chengdu Medical College, Chengdu, Sichuan 610500, China
| | - Yuwei Lin
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China; School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Ziyue Mi
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Ling Xiao
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China
| | - Zhong Liu
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China; School of Public Health, Anhui Medical University, Hefei 230032, China.
| | - Li Tian
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu 610052, China; Key Laboratory of Transfusion Adverse Reactions, Chinese Academy of Medical Sciences, China.
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2
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Das N, Prakash S, Sahu A, Panigrahi A, Mishra D, Mukherjee S. Impact of dose and storage duration of platelet concentrates on platelet recovery between ABO identical and ABO non-identical random donor platelet transfusions in hemato-oncology patients. Hematol Transfus Cell Ther 2024; 46:228-236. [PMID: 36941173 PMCID: PMC11221252 DOI: 10.1016/j.htct.2023.01.011] [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: 07/25/2022] [Revised: 10/11/2022] [Accepted: 01/16/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES It is challenging to adopt a policy of ABO identical platelet transfusion in hemato-oncological patients because of the high demand. Moreover, there are no global standards for the management of ABO non-identical platelet transfusions due to limited evidence. The current study compared the impact of dose and storage duration of platelets on percent platelet recovery (PPR) at 1 h and 24 h between ABO identical and ABO non-identical platelet transfusions in hemato-oncological conditions. The other objectives were to assess the clinical efficacy and compare adverse reactions between the two groups. METHODS A total of 130 random donor platelet transfusion episodes (81 ABO identical and 49 ABO non-identical) were evaluated in 60 eligible patients with different malignant, as well as non-malignant, hematological conditions. All analysis was performed using two-sided tests, and p-values <0.05 were considered significant. RESULTS The PPR at 1 h and 24 h was significantly higher in ABO identical platelet transfusion. Platelet recovery and survival were not affected by the gender, dose or storage duration of platelet concentrate. Aplastic anemia and myelodysplastic syndrome (MDS) disease conditions were observed to be independent risk predictors for 1-h post-transfusion refractoriness. CONCLUSION ABO identical platelets have higher platelet recovery and survival. Both ABO identical and ABO non-identical platelet transfusions have similar efficacy in controlling bleeding episodes up to World Health Organization (WHO) grade two. Assessment of other factors, such as platelet functional properties in the donor, anti-HLA and anti-HPA antibodies, may be needed to better understand the platelet efficacy of platelet transfusions.
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Affiliation(s)
- Niladri Das
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satya Prakash
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ansuman Sahu
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ashutosh Panigrahi
- Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debasish Mishra
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Somnath Mukherjee
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
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3
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Blumberg N, Nguyen PL, Asante A, Masel D, Henrichs K, Refaai M, Heal J, Love T. In response: ABO nonidentical platelet transfusions and mortality. Transfusion 2024; 64:954-956. [PMID: 38733606 DOI: 10.1111/trf.17839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/13/2024]
Affiliation(s)
- Neil Blumberg
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Phuong-Lan Nguyen
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Akua Asante
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Debra Masel
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Kelly Henrichs
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Majed Refaai
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Joanna Heal
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Division, University of Rochester Medical Center, Rochester, New York, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
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4
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Blumberg N, Asante AA, Nguyen PLT, Heal JM. Platelet Transfusions: The Good, the Bad, and the Ugly. Anesth Analg 2024; 138:921-924. [PMID: 38621279 DOI: 10.1213/ane.0000000000006918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Neil Blumberg
- From the Transfusion Medicine Division, Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, New York
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5
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Mokhtar G, Adly A, Baky AA, Ezzat D, Hakeem GA, Hassab H, Youssry I, Ragab I, Florez I, Sherief LM, El-Ekiaby M, Zakaria M, Hesham M, Shaheen N, Salama N, Salah N, Afifi RAA, El-Ashry R, Youssef S, Ragab S, Habib SA, Omar T, Amer Y, Wali Y, Makkeyah S. Transfusion of blood components in pediatric age groups: an evidence-based clinical practice guideline adapted for the use in Egypt using 'Adapted ADAPTE'. Ann Hematol 2024; 103:1373-1388. [PMID: 38388746 PMCID: PMC10940419 DOI: 10.1007/s00277-024-05657-4] [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: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
Pediatric transfusion is a complex area of medicine covering a wide age range, from neonates to young adults. Compared to adult practice, there is a relative lack of high-quality research to inform evidence-based guidelines. We aimed to adapt the pre-existing high-quality practice guidelines for the transfusion of blood components in different pediatric age groups to be available for national use by general practitioners, pediatricians, and other health care professionals. The guideline panel included 17 key leaders from different Egyptian institutions. The panel used the Adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to the target context of use. The guideline covered all important aspects of the indications, dosing, and administration of packed red cells, platelets, and fresh frozen plasma. It also included transfusion in special situations, e.g., chronic hemolytic anemia and aplastic anemia, management of massive blood loss, malignancies, surgery, recommendations for safe transfusion practices, and recommendations for modifications of cellular blood components. The final version of the adapted clinical practice guideline (CPG) has been made after a thorough review by an external review panel and was guided by their official recommendations and modifications. A set of implementation tools included algorithms, tables, and flow charts to aid decision-making in practice. This adapted guideline serves as a tool for safe transfusion practices in different pediatric age groups.
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Affiliation(s)
- Galila Mokhtar
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Amira Adly
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ashraf Abdel Baky
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Department of Pediatrics, MTI University, Cairo, Egypt
- Department of Pediatrics, Armed Forces College of Medicine (AFCM), Cairo, Egypt
| | - Dina Ezzat
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Beni Suef University, Beni Suef, Egypt
| | - Gehan Abdel Hakeem
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Minia University, Minia, Egypt
| | - Hoda Hassab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Alexandria University, Alexandria, Egypt
| | - Ilham Youssry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Iman Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Ivan Florez
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Laila M Sherief
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Magdy El-Ekiaby
- Department of Clinical Pathology and Transfusion Medicine, Shabrawishi Hospital, Cairo, Egypt
| | - Marwa Zakaria
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Mervat Hesham
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Zagazig University, Zagazig, Egypt
| | - Naglaa Shaheen
- Pediatric Hematology Department, Misr Children's Hospital, Health Insurance Organization, Cairo, Egypt
| | - Niveen Salama
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Nouran Salah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | - Rasha A A Afifi
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Rasha El-Ashry
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Mansoura University, Monsoura, Egypt
| | - Salwa Youssef
- Department of Clinical Pathology and Transfusion Medicine, Ain Shams University, Cairo, Egypt
| | - Seham Ragab
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Menoufia University, Menoufia, Egypt
| | - Sonia A Habib
- Pediatric Hematology and Oncology Unit, National Research Center, Giza, Egypt
| | - Tarek Omar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasser Amer
- Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
- Department of Pediatrics, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Yasser Wali
- Pediatric Hematology/Oncology Unit, Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sara Makkeyah
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Ain Shams University, Cairo, Egypt.
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Panch SR, Guo L, Vassallo R. Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management. Blood Rev 2023; 62:101135. [PMID: 37805287 DOI: 10.1016/j.blre.2023.101135] [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: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Platelet transfusion refractoriness due to HLA alloimmunization presents a significant medical problem, particularly among multiply transfused patients with hematologic malignancies and those undergoing hematopoietic stem cell transplants. HLA compatible platelet transfusions also impose significant financial burden on these patients. Recently, several novel mechanisms have been described in the development of HLA alloimmunization and platelet transfusion refractoriness. We review the history of platelet transfusions and mechanisms of HLA-sensitization and transfusion refractoriness. We also summarize advances in the diagnosis and treatment of platelet transfusion refractoriness due to HLA alloimmunization.
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Affiliation(s)
- Sandhya R Panch
- Clinical Research Division, Fred Hutchinson Cancer Center, United States of America; BloodWorks NorthWest, United States of America.
| | - Li Guo
- BloodWorks NorthWest, United States of America; Division of Hematology and Oncology, University of Washington School of Medicine, United States of America
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7
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Bougie DW, Reese SE, Birch RJ, Bookwalter DB, Mitchell PK, Roh D, Kreuziger LB, Cable RG, Goel R, Gottschall J, Hauser RG, Hendrickson JE, Hod EA, Josephson CD, Kahn S, Kleinman SH, Mast AE, Ness PM, Roubinian NH, Sloan S. Associations between ABO non-identical platelet transfusions and patient outcomes-A multicenter retrospective analysis. Transfusion 2023; 63:960-972. [PMID: 36994786 PMCID: PMC10175171 DOI: 10.1111/trf.17319] [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: 11/17/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Due to platelet availability limitations, platelet units ABO mismatched to recipients are often transfused. However, since platelets express ABO antigens and are collected in plasma which may contain ABO isohemagglutinins, it remains controversial as to whether ABO non-identical platelet transfusions could potentially pose harm and/or have reduced efficacy. STUDY DESIGN AND METHODS The large 4-year publicly available Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) database was used to investigate patient outcomes associated with ABO non-identical platelet transfusions. Outcomes included mortality, sepsis, and subsequent platelet transfusion requirements. RESULTS Following adjustment for possible confounding factors, no statistically significant association between ABO non-identical platelet transfusion and increased risk of mortality was observed in the overall cohort of 21,176 recipients. However, when analyzed by diagnostic category and recipient ABO group, associations with increased mortality for major mismatched transfusions were noted in two of eight subpopulations. Hematology/Oncology blood group A and B recipients (but not group O) showed a Hazard Ratio (HR) of 1.29 (95%CI: 1.03-1.62) and intracerebral hemorrhage group O recipients (but not groups A and B) showed a HR of 1.75 (95%CI: 1.10-2.80). Major mismatched transfusions were associated with increased odds of receiving additional platelet transfusion each post-transfusion day (through day 5) regardless of the recipient blood group. DISCUSSION We suggest that prospective studies are needed to determine if specific patient populations would benefit from receiving ABO identical platelet units. Our findings indicate that ABO-identical platelet products minimize patient exposure to additional platelet doses.
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Affiliation(s)
| | - Sarah E. Reese
- Public Health and Epidemiology Practice, Westat, Rockville, MD
| | | | | | | | | | | | | | - Ruchika Goel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Ronald George Hauser
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeanne E. Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT
- Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA
| | - Eldad A. Hod
- Columbia University Irving Medical Center, New York, NY
| | - Cassandra D. Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, FL., and Departments of Oncology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Alan E Mast
- Blood Research Institute, Versiti Milwaukee WI
| | - Paul M. Ness
- American Red Cross Scientific Affairs, Farmington, CT
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8
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Ali K, Müller TH, Garritsen HSP, Harringer W, Doescher A. Digital polymerase chain reaction to monitor platelet transfusions in cardiac surgery patients. Vox Sang 2023; 118:384-391. [PMID: 36912154 DOI: 10.1111/vox.13422] [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: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Corrected count increment (CCI) measurements monitor the effectiveness of platelet transfusions in haemato-oncology, but they usually fail in patients undergoing cardiac surgery. We investigated whether polymerase chain reaction (PCR) of mitochondrial single-nucleotide polymorphisms (SNPs) is able to monitor the survival of transfused platelets in these patients. MATERIALS AND METHODS Leukocyte-free, platelet-rich plasma was prepared from patients' blood to measure platelet counts based on patient-/donor-specific SNPs by digital PCR after DNA extraction. Platelet counts in samples from patients with severe thrombocytopenia were analysed by both PCR and flow cytometry. Ten patients undergoing cardiac surgery with the use of heart lung machine and without overt bleeding received a single apheresis platelet concentrate because of either dual platelet inhibition during a non-elective intervention or a complex procedure. Blood samples were collected at nine defined intervals (0-120 h) post transfusion. RESULTS The digital PCR of the seven SNPs reliably quantified levels ≥0.6 G/L platelets, in good agreement with flow cytometry and without interference by other SNPs or by platelet activation. A mean 24-h CCI of 11.8 (range: 5.6-19.8) and a mean 120-h area under the curve (AUC) of 1386 (915-1821) hxG/L were observed for the transfused platelets. The mean AUC of 14,103 (3415-27,305) hxG/L for the patients' endogenous platelets indicates that transfused platelets represented only 11% (5-25) of the total platelet counts during 120 h post transfusion. CONCLUSION PCR of mitochondrial SNPs offers a tool to assess the survival of platelets from apheresis concentrates in cardiac surgery patients to facilitate the implementation of improved transfusion strategies.
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Affiliation(s)
- Khaldoun Ali
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Thomas H Müller
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Henk S P Garritsen
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany.,Department of Atmospheric Pressure Plasma Processes, Fraunhofer Institute for Surface Engineering and Thin Films IST, Braunschweig, Germany
| | - Wolfgang Harringer
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Andrea Doescher
- Department of Transfusion Medicine, Blood Donor Service NSTOB, Oldenburg, Germany
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9
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Blumberg N, Heal JM. How do we forecast tomorrow's transfusion? - Next generation transfusion practices to improve recipient safety. Transfus Clin Biol 2023; 30:31-34. [PMID: 36096445 DOI: 10.1016/j.tracli.2022.09.005] [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] [Indexed: 02/07/2023]
Abstract
Recipient safety measures play a key role in overall transfusion efficacy. The key advances in safety over the first century of transfusion medicine have been the development of techniques to prevent hemolytic transfusion reactions, hemolytic disease of the newborn and transmission of viral pathogens. While these risks remain important, they affect many fewer patients than previously. We propose that some of the most important current safety issues relate to toxicities broadly encompassed by the immunomodulatory effects of allogeneic transfusion. These include (1) universal leukoreduction to mitigate nosocomial infections, inflammation and organ injury, (2) removal of stored supernatant and its attendant toxic contents that cause dysfunctional immunity and organ injury, (3) avoiding infusing ABO incompatible antigen and antibody that can lead to bleeding, platelet refractoriness and inflammation, (3) minimizing prophylactic transfusions (particularly of plasma and platelets) except where benefit is proven, and (4) avoiding use of normal saline which is linked to renal failure and possibly hemolysis. Accompanying these safety measures will be the continued growth of one of the most important safety measures, patient blood management, which has as one benefit the avoidance of unnecessary and harmful transfusions. Reducing the toxicity of transfusions will enhance the improved clinical outcomes seen with patient blood management.
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Affiliation(s)
- Neil Blumberg
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Joanna Mary Heal
- Transfusion Medicine, Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Box 608, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Garraud O, Hamzeh-Cognasse H, Chalayer E, Duchez AC, Tardy B, Oriol P, Haddad A, Guyotat D, Cognasse F. Platelet transfusion in adults: An update. Transfus Clin Biol 2023; 30:147-165. [PMID: 36031180 DOI: 10.1016/j.tracli.2022.08.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 106 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.
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Affiliation(s)
- O Garraud
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France.
| | | | - E Chalayer
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - A C Duchez
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - B Tardy
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - P Oriol
- CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - A Haddad
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Sacré-Cœur Hospital, Beirut, Lebanon; Lebanese American University, Beirut, Lebanon
| | - D Guyotat
- Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - F Cognasse
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
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11
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Shamsasenjan K, Gharehdaghi S, Khalaf-Adeli E, Pourfathollah AA. New horizons for reduction of blood use: Patient blood management. Asian J Transfus Sci 2023; 17:108-116. [PMID: 37188016 PMCID: PMC10180789 DOI: 10.4103/ajts.ajts_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/11/2022] [Accepted: 08/07/2022] [Indexed: 05/17/2023] Open
Abstract
A countrywide study over the eras indicates overuse of blood transfusion can have considerable risks to patients accompanied by significant costs of blood transfusion for patients, hospitals, and health-care systems. Besides, more than 30% of the world's population is anemic. Typically, blood transfusion helps continue suitable oxygen transfer in anemia, i.e., more and more documented as a threatening factor with several adverse outcomes including long hospitalization, morbidity, and mortality. Transplantation of allogeneic blood is thus like a two-edged sword. There is no doubt that the blood transfusion is a life-saving treatment, but it should be underpinned by much of up-to-date health-care services. The new theory considered for patient blood management (PBM) also discusses the timely application of evidence-based surgical and clinical theories and focuses on patient outcomes. Furthermore, PBM involves a multidisciplinary methodology to reduce unnecessary transfusions, minimize costs, and cut risks.
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Affiliation(s)
- Karim Shamsasenjan
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Gharehdaghi
- Department of Immunology, Division of Hematology, Faculty of Medicine, Tabriz University of Medical Sciences, Tehran, Iran
| | - Elham Khalaf-Adeli
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Ali Akbar Pourfathollah
- Department of Immunology, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
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12
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Walker BS, Schmidt RL, Moore RA, White SK, Fisher MA, Metcalf RA. Bacterial culture time to detection in platelet components: An evidence synthesis and estimation of detection failures. Transfusion 2023; 63:182-192. [PMID: 36371753 DOI: 10.1111/trf.17179] [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: 08/17/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Non-pathogen reduction platelet bacterial risk control strategies in the US FDA guidance include at least one culture. Almost all of these strategies have a culture hold time of ≥12 h. Studies have reported time to detection (TTD) of bacterial cultures inoculated with bacteria from contaminated platelets, but these data and estimates of risk associated with detection failures have not been synthesized. METHODS We performed a literature search to identify studies reporting TTD for samples obtained from spiked platelet components. Using extracted data, regression analysis was used to estimate TTD for culture bottles at different inoculum sizes. Detection failures were defined as events in which contaminated components are transfused to a patient. We then used published data on time of transfusion (ToT) to estimate the risk of detection failures in practice. RESULTS The search identified 1427 studies, of which 16 were included for analysis. TTD data were available for 16 different organisms, including 14 in aerobic cultures and 11 in anaerobic cultures. For inocula of 1 colony forming unit (CFU), the average TTD for aerobic organisms was 19.2 h while it was 24.9 h in anaerobic organisms, but there was substantial overall variation. A hold time of 12 versus 24 h had minimal effect for most organisms. CONCLUSION TTD variation occurs between bacterial species and within a particular species. Under typical inventory management, the relative contribution of culture detection failures is much smaller than the residual risk from sampling failures. Increasing the hold period beyond 12 h has limited value.
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Affiliation(s)
| | - Robert L Schmidt
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryleigh A Moore
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
| | - Sandra K White
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Mark A Fisher
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan A Metcalf
- ARUP Laboratories, Salt Lake City, Utah, USA.,Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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13
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Reade MC, Marks DC, Howe B, McGuinness S, Parke R, Navarra L, Charlewood R, Johnson L, McQuilten Z. Cryopreserved platelets compared with liquid-stored platelets for the treatment of surgical bleeding: protocol for two multicentre randomised controlled blinded non-inferiority trials (the CLIP-II and CLIPNZ-II trials). BMJ Open 2022; 12:e068933. [PMID: 36600425 PMCID: PMC9772641 DOI: 10.1136/bmjopen-2022-068933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Cryopreservation at -80°C in dimethylsulphoxide extends platelet shelf-life from 7 days to 2 years. Only limited comparative trial data supports the safety and effectiveness of cryopreserved platelets as a treatment for surgical bleeding. Cryopreserved platelets are not currently registered for civilian use in most countries. METHODS AND ANALYSIS CLIP-II and CLIPNZ-II are harmonised, blinded, multicentre, randomised, controlled clinical non-inferiority trials comparing bleeding, transfusion, safety and cost outcomes associated with cryopreserved platelets versus conventional liquid platelets as treatment for bleeding in cardiac surgery. CLIP-II is planning to enrol patients in 12 tertiary hospitals in Australia; CLIPNZ-II will recruit in five tertiary hospitals in New Zealand. The trials use near-identical protocols aside from details of cryopreserved platelet preparation. Patients identified preoperatively as being at high risk of requiring a platelet transfusion receive up to three units of study platelets if their treating doctor considers platelet transfusion is indicated. The primary endpoint is blood loss through the surgical drains in the 24 hours following intensive care unit (ICU) admission after surgery. Other endpoints are blood loss at other time points, potential complications, adverse reactions, transfusion and fluid requirement, requirement for procoagulant treatments, time to commencement of postoperative anticoagulants, delay between platelet order and commencement of infusion, need for reoperation, laboratory and point-of-care clotting indices, cost, length of mechanical ventilation, ICU and hospital stay, and mortality. Transfusing 202 (CLIP-II) or 228 (CLIPNZ-II) patients with study platelets will provide 90% power to exclude the possibility of greater than 20% inferiority in the primary endpoint. If cryopreserved platelets are not inferior to liquid-stored platelets, the advantages of longer shelf-life would justify rapid change in clinical practice. Cost-effectiveness analyses will be incorporated into each study such that, should clinical non-inferiority compared with standard care be demonstrated, the hospitals in each country that would benefit most from changing to a cryopreserved platelet blood bank will be known. ETHICS AND DISSEMINATION CLIP-II was approved by the Austin Health Human Research Ethics Committee (HREC/54406/Austin-2019) and by the Australian Red Cross Lifeblood Ethics Committee (2019#23). CLIPNZ-II was approved by the New Zealand Southern Health and Disability Ethics Committee (21/STH/66). Eligible patients are approached for informed consent at least 1 day prior to surgery. There is no provision for consent provided by a substitute decision-maker. The results of the two trials will be submitted separately for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBERS NCT03991481 and ACTRN12621000271808.
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Affiliation(s)
- Michael C Reade
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Denese C Marks
- Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Belinda Howe
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Shay McGuinness
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rachael Parke
- Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Leanlove Navarra
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Lacey Johnson
- Australian Red Cross Lifeblood, Alexandria, New South Wales, Australia
| | - Zoe McQuilten
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
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14
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Thrombocytopenia in Patients With Myelofibrosis: A Practical Management Guide. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1067-e1074. [PMID: 36117043 DOI: 10.1016/j.clml.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023]
Abstract
Patients with myelofibrosis (MF) frequently develop thrombocytopenia as a consequence of bone marrow fibrosis, splenic sequestration, and myelosuppression from an inflammatory microenvironmental milieu. Thrombocytopenia occurs frequently at diagnosis, worsens with disease progression, is an independent adverse prognostic factor, and limits effective dosing of JAK2 inhibitors. Recently, pacritinib was approved for patients with MF and extreme thrombocytopenia. However, this JAK2/IRAK1 inhibitor is not primarily used to attain improvement in platelet count. In this narrative review, we discuss strategies to specifically address thrombocytopenia in MF patients including immunomodulatory drugs, synthetic androgens, hypomethylating agents and splenectomy, all of which have only modest efficacy in alleviating thrombocytopenia. We also detail transfusion approaches, including diagnostic and therapeutic consideration for platelet transfusion refractoriness. We end by discussing novel therapies, including TGFβ traps and recombinant pentraxin-2, which may increase platelet counts in MF patients. Despite recent therapeutic advancements in MF, there remains a near paucity of agents that can effectively alleviate thrombocytopenia.
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15
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Abstract
Platelet transfusions are commonly administered for the prevention or treatment of bleeding in patients with acquired thrombocytopenia across a range of clinical contexts. Recent data, including randomized trials, have highlighted uncertainties in the risk-benefit balance of this therapy, which is the subject of this review. Hemovigilance systems report that platelets are the most frequently implicated component in transfusion reactions. There is considerable variation in platelet count increment after platelet transfusion, and limited evidence of efficacy for clinical outcomes, including prevention of bleeding. Bleeding events commonly occur despite the different policies for platelet transfusion prophylaxis. The underlying mechanisms of harm reported in randomized trials may be related to the role of platelets beyond hemostasis, including mediating inflammation. Research supports the implementation of a restrictive platelet transfusion policy. Research is needed to better understand the impact of platelet donation characteristics on outcomes, and to determine the optimal thresholds for platelet transfusion before invasive procedures or major surgery (eg, laparotomy). Platelet transfusion policies should move toward a risk-adapted approach that does not focus solely on platelet count.
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16
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Kuroishi A, Takihara Y, Hirayama F. Current understanding and future perspectives for anti-human platelet antigen-15 antibodies in patients with alloimmune thrombocytopenia: History, laboratory testing, and clinical impact. Transfusion 2022; 62:1128-1141. [PMID: 35266549 DOI: 10.1111/trf.16845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ayumu Kuroishi
- Laboratory, Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
| | | | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Center, Ibaraki-shi, Osaka, Japan
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17
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Ohanian M, Cancelas JA, Davenport R, Pullarkat V, Hervig T, Broome C, Marek K, Kelly M, Gul Z, Rugg N, Nestheide S, Kinne B, Szczepiorkowski Z, Kantarjian H, Pehta J, Biehl R, Yu A, Aung F, Antebi B, Fitzpatrick GM. Freeze-dried platelets are a promising alternative in bleeding thrombocytopenic patients with hematological malignancies. Am J Hematol 2022; 97:256-266. [PMID: 34748664 DOI: 10.1002/ajh.26403] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
Thrombosomes are trehalose-stabilized, freeze-dried group O platelets with a 3-year shelf life. They can be stockpiled, rapidly reconstituted, and infused regardless of the recipient's blood type. Thrombosomes thus represent a potential alternative platelet transfusion strategy. The present study assessed the safety and potential early signals of efficacy of Thrombosomes in bleeding thrombocytopenic patients. We performed an open-label, phase 1 study of single doses of allogeneic Thrombosomes at three dose levels in three cohorts, each consisting of eight patients who had hematologic malignancies, thrombocytopenia, and bleeding. Adverse events, dose-limiting toxicities (DLTs), World Health Organization (WHO) bleeding scores, and hematology values were assessed. No DLTs were reported. The median age was 59 years (24-71). Most patients had AML (58%) or ALL (29%), followed by MDS (8%) and myeloproliferative neoplasm (4%). The WHO scores of 22 patients who were actively bleeding at a total of 27 sites at baseline either improved (n = 17 [63%]) or stabilized (n = 10 [37%]) through day 6. Twenty-four hours after infusion, 12 patients (50%) had a clinically significant platelet count increase. Of eight patients who received no platelet transfusions for 6 days after Thrombosomes infusion, 5 had a clinically significant increase in platelet count of ≥5000 platelets/μL and 2 had platelet count normalization. Thrombosomes doses up to 3.78 × 108 particles/kg demonstrated safety in 24 bleeding, thrombocytopenic patients with hematological malignancies. Thrombosomes may represent an alternative to conventional platelets to treat bleeding. A phase 2 clinical trial in a similar patient population is underway.
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Affiliation(s)
- Maro Ohanian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | | | | | - Vinod Pullarkat
- City of Hope Comprehensive Cancer Center Duarte California USA
| | - Tor Hervig
- Haukeland Universitetssjukehus Bergen Norway
| | - Catherine Broome
- MedStar Georgetown University Hospital Washington District of Columbia USA
| | - Kelly Marek
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Mary Kelly
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Zartash Gul
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | - Neeta Rugg
- Hoxworth Blood Center Cincinnati Ohio USA
| | | | - Bridget Kinne
- Division of Hematology/Oncology, Department of Internal Medicine University of Cincinnati College of Medicine Cincinnati Ohio USA
| | | | - Hagop Kantarjian
- Department of Leukemia The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Joan Pehta
- The Alpha Bio Group New Canaan Connecticut USA
| | - Ruth Biehl
- Cellphire Therapeutics Rockville Maryland USA
| | - Anna Yu
- Cellphire Therapeutics Rockville Maryland USA
| | - Fleur Aung
- Department of Transfusion Medicine The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Ben Antebi
- Cellphire Therapeutics Rockville Maryland USA
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18
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Kenan N, Diabat A. The supply chain of blood products in the wake of the COVID-19 pandemic: Appointment scheduling and other restrictions. TRANSPORTATION RESEARCH. PART E, LOGISTICS AND TRANSPORTATION REVIEW 2022; 159:102576. [PMID: 35125922 PMCID: PMC8800153 DOI: 10.1016/j.tre.2021.102576] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 11/16/2021] [Accepted: 12/03/2021] [Indexed: 05/16/2023]
Abstract
In this work, we formulate the blood products supply chain problem in the wake of disasters such as the COVID-19 (SARS-CoV-2) pandemic using two-stage stochastic programming where uncertainty of both demand and supply is considered. The products considered are red blood cells (RBCs), plasma, and platelets. Age-based demand and blood type substitution are included in our model. A heuristic is developed to solve the instances a commercial optimization software failed to solve in a reasonable amount of time. To obtain managerial insight a sensitivity analysis is conducted. Results of the analysis show that bigger capacities of permanent collection facilities are favored over the mobility of temporary facilities while accounting for blood substitution and age-based demand in the planning phase reduced shortages significantly. Moreover, different objective functions were considered to ensure fairness in distribution of the products among hospitals. The fairer distribution resulted in an increase in the total unmet demand.
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Affiliation(s)
- Nabil Kenan
- Division of Engineering, New York University Abu Dhabi, Saadiyat Island, 129188, Abu Dhabi, United Arab Emirates
| | - Ali Diabat
- Division of Engineering, New York University Abu Dhabi, Saadiyat Island, 129188, Abu Dhabi, United Arab Emirates
- Department of Civil and Urban Engineering, Tandon School of Engineering, New York University, Brooklyn, NY 11201, United States of America
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19
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Gao M, Huang J, Shao Y, Ge M, Li X, Zhang J, Wang M, Nie N, Jin P, Zheng Y. Efficacy of anti-thymocyte globulin for platelet transfusion refractoriness in serious aplastic anemia patients. Transfus Apher Sci 2022; 61:103376. [PMID: 35120830 DOI: 10.1016/j.transci.2022.103376] [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: 10/25/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
Platelet transfusion refractoriness (PTR) is a life threatening, intractable clinical issue suffered by some serious aplastic anemia (SAA) patients. Unlike immune thrombocytopenia, effective treatments for PTR remain largely unknown. In our clinical work, we noted that PTR in some SAA patients could be rapidly relieved with the application of anti-thymocyte globulin (ATG), therefore, we retrospectively analyzed its management and outcomes for PTR in SAA patients. A cohort including 29 SAA with PTR patients who received ATG administration was enrolled in this study. All patients suffered from PTR before ATG administration. Among the 29 PTR patients treated with ATG, 21 (72.4.0 %) patients had response, importantly, 13 (44.8 %) patients had an immediately response following the first dose of ATG administration. Bleeding events of grade 3 or above occurred in 23 patients (79.3 %). With the recovery of effective platelet transfusion, the bleeding events in responders could be quickly relieved. The non-responders suffered from aggravated bleeding, including intracranial bleeding in two non-responders, which appeared on eighth and 29th days after ATG administration. Our study indicated that ATG was an effective and safe intervention in the management of PTR in SAA patients.
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Affiliation(s)
- Mengying Gao
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Jinbo Huang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
| | - Yingqi Shao
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Meili Ge
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Xingxin Li
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Jing Zhang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Min Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Neng Nie
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Peng Jin
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China
| | - Yizhou Zheng
- State Key Laboratory of Experimental Hematology, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, 300020, China.
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20
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Prevalence, Risk Factors, and Outcomes of Platelet Transfusion Refractoriness in Critically Ill Patients: A Retrospective Cohort Study. Crit Care Res Pract 2021; 2021:5589768. [PMID: 34603795 PMCID: PMC8486553 DOI: 10.1155/2021/5589768] [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: 02/08/2021] [Revised: 08/03/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background Refractoriness to platelet transfusion is an understudied phenomenon in critically ill patients. Our objective was to evaluate the prevalence, risk factors, and clinical outcomes of platelet refractoriness among patients in a tertiary-care intensive care unit (ICU). Methods A retrospective cohort study included all patients (age >14 years) who were admitted to a tertiary-care medical-surgical ICU between 2011 and 2016 and received ≥2 platelet transfusions during their ICU stay. We calculated platelet increment (PI) and corrected count increment (CCI). Results A total of 267 patients were enrolled in the study, collectively receiving 1357 transfusions with a median of 4.0 (interquartile range: 2.0, 6.0) transfusions per patient. The median pretransfusion platelet count was 31000.0 × 106/L (interquartile range: 16000.0, 50000.0). The median PI was 6000 × 106/L. The prevalence of platelet transfusion refractoriness was 54.8% based on PI < 10000 × 106/L and 57.0% based on CCI <5000. Patients admitted under hepatology/liver transplant had the highest rates of platelet refractoriness (69.6%), while those under general surgery had the lowest rate (43.2%). Younger age, nontrauma admission, and larger spleen size were associated with platelet refractoriness. Finally, refractoriness was associated with increased length of stay in the ICU (p = 0.02), but not with mortality. Conclusions Platelet transfusion refractoriness was highly (>50%) prevalent in ICU patients. However, it was not associated with increased mortality.
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21
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Karlström C, Gryfelt G, Schmied L, Meinke S, Höglund P. Platelet transfusion improves clot formation and platelet function in severely thrombocytopenic haematology patients. Br J Haematol 2021; 196:224-233. [PMID: 34528253 DOI: 10.1111/bjh.17820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
Prophylactic platelet (PLT) transfusion is a common practice in severely thrombocytopenic patients that reduces mortality, but responses to platelet transfusions are variable and difficult to predict in individual patients. In this prospective study, we evaluated the outcome of PLT transfusions in 40 patients with haematological malignancies, linking corrected count increment (CCI) to clot formation and agonist-induced platelet activation after transfusion. The CCI was highly variable between patients and 34% showed no response (1-h CCI < 7,5). Short time since the last PLT transfusion and extended storage time of the PLT product were linked to poor transfusion response, while patient sex, C-reactive protein or the number of chemotherapy cycles prior to transfusion did not influence transfusion outcome. High CCI and good PLT responsiveness to agonist stimulation predicted efficient clot formation in rotational thromboelastometry, but transfusion did not restore poor PLT function in patients to the level of healthy controls. Our study provides new insights into factors affecting PLT transfusion outcome in haematology patients with severe thrombocytopenia, and suggests that the thrombocytopenic environment, or disease-associated factors, may hamper platelet responsiveness.
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Affiliation(s)
- Cecilia Karlström
- Department of Medicine Huddinge, Center for Haematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden.,Medical Unit Haematology, Karolinska University Hospital, Stockholm, Sweden
| | - Gunilla Gryfelt
- Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Laurent Schmied
- Department of Medicine Huddinge, Center for Haematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden
| | - Stephan Meinke
- Department of Medicine Huddinge, Center for Haematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden
| | - Petter Höglund
- Department of Medicine Huddinge, Center for Haematology and Regenerative Medicine (HERM), Karolinska Institutet, Stockholm, Sweden.,Medical Unit Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
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22
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Cardigan R, New HV, Estcourt L, Zhiburt E, Dubey R, Bengtsson J, Jöud M, Castillo C, Cid J, Lozano M, Gounder D, Flanagan P, Morley S, Clarke G, Devine D, Hindawi S, AlOtaibi A, Bub CB, Kutner JM, Ikeda T, Goto N, Okazaki H, Fontaine MJ, Pasion J, Song L, Latham T, Kerkhoffs JL, de Haas M, Zwaginga JJ, Gathof BS, Ommer K, Pirenne F, Raba M, Francois A, Daly J, Powley T, Dunbar N. International Forum on Policies and Practice for Transfusion of ABO and RhD Non-Identical Platelets: Summary. Vox Sang 2021; 117:136-144. [PMID: 34258783 DOI: 10.1111/vox.13129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/16/2023]
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23
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Åkesson A, Ljungkvist M, Martin M, Blom AM, Klintman J, Schött U, Zetterberg E, Kander T. Biomarkers of complement and platelet activation are not correlated with the one or twenty-four hours corrected count increments in prophylactically platelet transfused hematological patients: a prospective cohort study. Platelets 2021; 33:350-359. [PMID: 34210243 DOI: 10.1080/09537104.2021.1942817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Platelet transfusion refractoriness is a serious clinical concern that complicates the management of thrombocytopenic patients. Previous studies have suggested a potential role for both complement and platelet activation based on in vitro analyses of platelet concentrates. In this study, the post-transfusion platelet response, as indicated by the corrected count increment at 1 and 24 h after prophylactic platelet transfusions, respectively, was correlated with the 1 h post-transfusion Δconcentration (1 h post-transfusion - pretransfusion) of complement and platelet activation biomarkers. The study was registered as a clinical trial at ClinicalTrials.gov (identifier: NCT02601131) and patients were recruited during inpatient care in the hematological department. Soluble terminal complement complexes, soluble P-selectin and soluble CD40 ligand were analyzed. Confirmed alloimmunized patients were excluded. Included subjects were either given platelet transfusions (n = 43) and categorized into four clinical study groups or included in a non-transfused control group (n = 10). In total, 54 transfusions were included. No transfusion-mediated complement activation was observed. The transfusions were associated with a significant increase in the concentration of soluble P-selectin (p < .001), primarily corresponding to the passive infusion of soluble P-selectin-containing plasma residuals. The Δconcentration of soluble P-selectin was, however, not significantly correlated with the corrected count increments. Thus, significant correlations between biomarkers of complement and platelet activation and the post-transfusion platelet response could not be demonstrated in this study.
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Affiliation(s)
- Alexander Åkesson
- The Clinical Coagulation Research Unit, Department of Translational Medicine, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Marcus Ljungkvist
- Department of Clinical Chemistry and Pharmacology, University and Regional Laboratories, Region Skåne, Malmö, Sweden
| | - Myriam Martin
- The Medical Protein Chemistry Research Group, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Anna M Blom
- The Medical Protein Chemistry Research Group, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Jenny Klintman
- The Clinical Coagulation Research Unit, Department of Translational Medicine, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Ulf Schött
- Anesthesia and Intensive Care, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Eva Zetterberg
- The Clinical Coagulation Research Unit, Department of Translational Medicine, Lund University and Skåne University Hospital, Malmö, Sweden
| | - Thomas Kander
- Anesthesia and Intensive Care, Department of Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
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Krishnaswamy S, Ageno W, Arabi Y, Barbui T, Cannegieter S, Carrier M, Cleuren AC, Collins P, Panicot-Dubois L, Freedman JE, Freson K, Hogg P, James AH, Kretz CA, Lavin M, Leebeek FWG, Li W, Maas C, Machlus K, Makris M, Martinelli I, Medved L, Neerman-Arbez M, O'Donnell JS, O'Sullivan J, Rajpurkar M, Schroeder V, Spiegel PC, Stanworth SJ, Green L, Undas A. Illustrated State-of-the-Art Capsules of the ISTH 2020 Congress. Res Pract Thromb Haemost 2021; 5:e12532. [PMID: 34296056 PMCID: PMC8285574 DOI: 10.1002/rth2.12532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022] Open
Abstract
This year's Congress of the International Society of Thrombosis and Haemostasis (ISTH) was hosted virtually from Philadelphia July 17-21, 2021. The conference, now held annually, highlighted cutting-edge advances in basic, population and clinical sciences of relevance to the Society. Despite being held virtually, the 2021 congress was of the same scope and quality as an annual meeting held in person. An added feature of the program is that talks streamed at the designated times will then be available on-line for asynchronous viewing. The program included 77 State of the Art (SOA) talks, thematically grouped in 28 sessions, given by internationally recognized leaders in the field. The SOA speakers were invited to prepare brief illustrated reviews of their talks that were peer reviewed and are included in this article. The topics, across the main scientific themes of the congress, include Arterial Thromboembolism, Coagulation and Natural Anticoagulants, COVID-19 and Coagulation, Diagnostics and Omics, Fibrinogen, Fibrinolysis and Proteolysis, Hemophilia and Rare Bleeding Disorders, Hemostasis in Cancer, Inflammation and Immunity, Pediatrics, Platelet Disorders, von Willebrand Disease and Thrombotic Angiopathies, Platelets and Megakaryocytes, Vascular Biology, Venous Thromboembolism and Women's Health. These illustrated capsules highlight the major scientific advances with potential to impact clinical practice. Readers are invited to take advantage of the excellent educational resource provided by these illustrated capsules. They are also encouraged to use the image in social media to draw attention to the high quality and impact of the science presented at the congress.
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Affiliation(s)
- Sriram Krishnaswamy
- Hematology Department of Pediatrics Children's Hospital of Philadelphia Perelman School of Medicine University of Pennsylvania Philadelphia PA USA
| | | | - Yaseen Arabi
- King Abdulaziz Medical City Ministry of NGHA King Saud Bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia
| | - Tiziano Barbui
- Research Foundation Papa Giovanni XXIII Hospital Bergamo Italy
| | - Suzanne Cannegieter
- Depertments of Clinical Epidemiology and Thrombosis & Haemostasis Leiden University Medical Center Leiden The Netherlands
| | - Marc Carrier
- Department of Medicine Ottawa Hospital Research Institute University of Ottawa Ottawa ON Canada
| | | | - Peter Collins
- School of Medicine Cardiff University Haemophilia Centre University Hospital of Wales Cardiff UK
| | | | - Jane E Freedman
- Vanderbilt University Medical Center The Albert Sherman Center Worcester MA USA
| | - Kathleen Freson
- Center for Molecular and Vascular Biology KU Leuven Leuven Belgium
| | - Philip Hogg
- Charles Perkins Centre University of Sydney Sydney NSW Australia
| | | | | | - Michelle Lavin
- National Coagulation Centre St. James's Hospital Dublin Ireland
- Irish Centre for Vascular Biology RCSI Dublin Ireland
| | - Frank W G Leebeek
- Department of Hematology Erasmus MC University Medical Center Rotterdam The Netherlands
| | - Weikai Li
- Washington University in St. Louis Medical School St. Louis MO USA
| | - Coen Maas
- University Medical Center Utrecht Utrecht The Netherlands
| | - Kellie Machlus
- Vascular Biology Program and Harvard Medical School Boston Children's Hospital Boston MA USA
| | | | - Ida Martinelli
- Hemophilia and Thrombosis Center IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico Milano Italy
| | - Leonid Medved
- Center for Vascular and Inflammatory Diseases and Department of Biochemistry and Molecular Biology University of Maryland School of Medicine Baltimore MD USA
| | - Marguerite Neerman-Arbez
- Deartment of Genetic Medicine and Development Faculty of Medicine University of Geneva Geneva Switzerland
| | - James S O'Donnell
- Haemostasis Research Group Irish Centre for Vascular Biology School of Pharmacy and Biomolecular Sciences Royal College of Surgeons in Ireland Dublin Ireland
- National Children's Research Centre Our Lady's Children's Hospital Dublin Ireland
- National Centre for Coagulation Disorders St James's Hospital Dublin Ireland
| | - Jamie O'Sullivan
- Irish Centre for Vascular Biology School of Pharmacy and Biomolecular Science Royal College of Surgeons in Ireland Dublin Ireland
| | - Madhvi Rajpurkar
- Children's Hospital of Michigan Central Michigan University Detroit MI USA
- Wayne State University Detroit MI USA
| | - Verena Schroeder
- Department for BioMedical Research University of Bern Bern Switzerland
| | | | - Simon J Stanworth
- Transfusion Medicine NHS Blood and Transplant Oxford UK
- Department of Haematology Oxford University Hospitals NHS Foundation Trust Oxford UK
- Radcliffe Department of Medicine NIHR Oxford Biomedical Research Centre University of Oxford Oxford UK
| | - Laura Green
- Transfusion Medicine NHS Blood and Transplant (London) and Barts Health NHS Trust London UK
- Blizzard Institute Queen Mary University of London London UK
| | - Anetta Undas
- Jagiellonian University Medical College Krakow Poland
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Impacts of ABO-incompatible platelet transfusions on platelet recovery and outcomes after intracerebral hemorrhage. Blood 2021; 137:2699-2703. [PMID: 33649761 DOI: 10.1182/blood.2020008381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/07/2021] [Indexed: 11/20/2022] Open
Abstract
Acute platelet transfusion after intracerebral hemorrhage (ICH) given in efforts to reverse antiplatelet medication effects and prevent ongoing bleeding does not appear to improve outcome and may be associated with harm. Although the underlying mechanisms are unclear, the influence of ABO-incompatible platelet transfusions on ICH outcomes has not been investigated. We hypothesized that patients with ICH who receive ABO-incompatible platelet transfusions would have worse platelet recovery (using absolute count increment [ACI]) and neurological outcomes (mortality and poor modified Rankin Scale [mRS 4-6]) than those receiving ABO-compatible transfusions. In a single-center cohort of consecutively admitted patients with ICH, we identified 125 patients receiving acute platelet transfusions, of whom 47 (38%) received an ABO-incompatible transfusion. Using quantile regression, we identified an association of ABO-incompatible platelet transfusion with lower platelet recovery (ACI, 2 × 103cells per μL vs 15 × 103cells per μL; adjusted coefficient β, -19; 95% confidence interval [CI], -35.55 to -4.44; P = .01). ABO-incompatible platelet transfusion was also associated with increased odds of mortality (adjusted odds ratio [OR], 2.59; 95% CI, 1.00-6.73; P = .05) and poor mRS (adjusted OR, 3.61; 95% CI, 0.97-13.42; P = .06); however, these estimates were imprecise. Together, these findings suggest the importance of ABO compatibility for platelet transfusions for ICH, but further investigation into the mechanism(s) underlying these observations is required.
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Platelet Transfusion-Insights from Current Practice to Future Development. J Clin Med 2021; 10:jcm10091990. [PMID: 34066360 PMCID: PMC8125287 DOI: 10.3390/jcm10091990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022] Open
Abstract
Since the late sixties, therapeutic or prophylactic platelet transfusion has been used to relieve hemorrhagic complications of patients with, e.g., thrombocytopenia, platelet dysfunction, and injuries, and is an essential part of the supportive care in high dose chemotherapy. Current and upcoming advances will significantly affect present standards. We focus on specific issues, including the comparison of buffy-coat (BPC) and apheresis platelet concentrates (APC); plasma additive solutions (PAS); further measures for improvement of platelet storage quality; pathogen inactivation; and cold storage of platelets. The objective of this article is to give insights from current practice to future development on platelet transfusion, focusing on these selected issues, which have a potentially major impact on forthcoming guidelines.
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Dunbar NM. Does ABO and RhD matching matter for platelet transfusion? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:512-517. [PMID: 33275681 PMCID: PMC7727583 DOI: 10.1182/hematology.2020000135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Platelets express ABO antigens and are collected in plasma, which contains ABO antibodies as would be consistent with the donor ABO group. Platelet ABO antigens that are incompatible with recipient ABO antibodies may have accelerated clearance from circulation and result in lower count increments. ABO antibodies that are passively transferred from donor plasma may result in hemolysis of recipient red blood cells. Although platelets do not express Rh antigens, they contain small numbers of intact red blood cells or fragments, which can lead to alloimmunization in the recipient. Alloimmunization to the RhD antigen may occur when platelets obtained from RhD-positive donors are transfused to RhD-negative recipients. All of these compatibility considerations must be balanced against the available supply, which may be limited due to the 5- to 7-day shelf life of platelets. This articles describes considerations for platelet ABO and RhD selection for platelet transfusions, including the impact of major ABO incompatibility on count increments, the risks of hemolysis associated with minor ABO incompatibility, and the risk of RhD alloimmunization when RhD-negative patients receive platelets obtained from RhD-positive donors.
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Lieberman L, Liu Y, Barty R, Heddle NM. Platelet transfusion practice and platelet refractoriness for a cohort of pediatric oncology patients: A single-center study. Pediatr Blood Cancer 2020; 67:e28734. [PMID: 32975362 DOI: 10.1002/pbc.28734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/14/2020] [Accepted: 09/04/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Platelet transfusions are an essential aspect of supportive care for pediatric oncology patients. Data regarding the frequency of transfusions, pretransfusion thresholds, posttransfusion increments, and rate of platelet transfusion refractoriness (PTR) are lacking. STUDY OBJECTIVES (a) describe platelet transfusion practice for children with malignancy; (b) determine the normal platelet increment following platelet transfusion; and (c) assess rate of PTR. METHODS Inpatient pediatric oncology patients <18 years old and treated between 2009 and 2013 were identified. Data collected retrospectively included patient demographics, clinical information, laboratory values, and transfusion details. RESULTS Three hundred sixty-seven children were included and 144 (39%) received at least one platelet transfusion. Platelets were transfused during 25% of all inpatient admissions. The median number of platelet transfusion for any given inpatient admission was two (interquartile range [IQR]: 1-3). The median pretransfusion platelet count was 16 × 109 /L and posttransfusion increment was 25 × 109 /L. Most (79%) of the time, the pretransfusion platelet count was >10 × 109 /L. Older children who received ABO incompatible platelet transfusions with a longer storage duration were more likely to have a poor platelet response (increment ≤ 10 × 109 /L). The rate of PTR (immune and/or nonimmune) was low (8%; 11/144). CONCLUSIONS Practical information to parents and clinicians of newly diagnosed children regarding the likelihood and frequency of platelet transfusions was determined. The rate of PTR was low, supporting the hypothesis that children receiving leukoreduced products are at a low risk of PTR.
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Affiliation(s)
- Lani Lieberman
- Department of Clinical Pathology, University Health Network, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yang Liu
- Department of Medicine and the McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Rebecca Barty
- Department of Medicine and the McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Nancy M Heddle
- Department of Medicine and the McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
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29
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Inoue H, Sakamoto R, Nishimiya H, Sakamoto H, Terasu S, Aminaka R, Koh Y, Takihara Y, Hirayama F, Kuroishi A. Minor impact of patient alloantibodies against human platelet antigen (HPA)-15 in the effectiveness of platelet transfusion: A pilot study. Transfusion 2020; 61:738-743. [PMID: 33166416 DOI: 10.1111/trf.16181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alloantibodies against human platelet antigen (HPA)-15 are sometimes detected in patients with platelet transfusion refractoriness (PTR); however, little is known about their impact on PTR. STUDY DESIGN AND METHODS Two patients who possessed HPA-15 alloantibodies (Patient 1, anti-HPA-15b; Patient 2, anti-HPA-15a) and human leukocyte antigen (HLA) antibodies were enrolled. The efficacy of HPA-15-compatible vs -incompatible platelet transfusion was compared by focusing on ABO- and HLA-matched transfusions on the basis of the 24-hour corrected count increment (CCI-24 hours) for platelets. The titers of HPA-15 antibodies in the patients' sera were also monitored. RESULTS The patients received 71 and 12 ABO-compatible, HLA-matched platelet transfusions, respectively, during the monitoring periods. Among these transfusions, CCI-24 hours could be calculated in 27 and 10 transfusions, respectively, and the HPA-15 genotype of the donors was determined. There were no significant differences in the CCI-24 hours between the HPA-15 compatible and incompatible transfusions in both patients (P = .30 and .56, respectively, Mann-Whitney U test). There was no significant change in the HPA-15b antibody titer in Patient 1 during the monitoring period, while the HPA-15a antibody level in Patient 2 was undetectable at the end of the monitoring period, although the titer was low at the beginning. CONCLUSION The efficacy of HPA-15-incompatible platelet transfusions was not necessarily inferior to that of HPA-15 compatible ones. Although the case number was limited, our results suggest that HPA-15 antibodies do not have a significant impact on the effects of platelet transfusion.
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Affiliation(s)
- Hiroko Inoue
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Rumi Sakamoto
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | | | - Hiroe Sakamoto
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Shota Terasu
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Ryota Aminaka
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | - Yangsook Koh
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
| | | | | | - Ayumu Kuroishi
- Japanese Red Cross Kinki Block Blood Center, Ibaraki, Japan
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30
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Abstract
PURPOSE OF REVIEW In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets. RECENT FINDINGS Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study. SUMMARY Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.
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31
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Stefely JA, Gailey M, Knudson M, Dumont LJ, Raife TJ, Samia NI. Retrospective cohort studies of repeat donors reveal donor-dependent variability in the recovery of transfused platelets. Transfusion 2020; 60:1837-1845. [PMID: 32483843 DOI: 10.1111/trf.15865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The in vivo recovery of transfused platelets is variable and often unpredictable. Although many recipient-dependent factors are well described, donor-dependent variables remain poorly understood. STUDY DESIGN AND METHODS To explore donor-dependent variables we conducted 2 retrospective studies of platelet transfusion outcomes in repeat donors. One study analyzed multiple autologous, radiolabeled platelet transfusions, and a second study analyzed multiple clinical platelet transfusions from a small cohort of repeat donors. RESULTS In 36 subjects, multiple within-subject determinations of recovery and survival of radiolabeled autologous platelets revealed a relative consistency in platelet recoveries within donors compared to the range of recoveries among donors. Intraclass correlation coefficients for platelet recovery were 43% to 93%. In 524 ABO-compatible clinical platelet transfusions derived from seven donors, a linear mixed-effects model revealed significant donor-dependent differences in corrected count increments for units stored for 4 or 5 days. CONCLUSIONS These two studies indicate reproducible donor-dependent differences in transfused platelet recovery, suggesting a possible heritable influence on the quality of transfused platelets.
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Affiliation(s)
- Jonathan A Stefely
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Michael Gailey
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael Knudson
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Larry J Dumont
- Vitalant Research Institute, Denver, Colorado, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA.,Department of Pathology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Thomas J Raife
- Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Noelle I Samia
- Department of Statistics, Northwestern University, Evanston, Illinois, USA
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The MICELI (MICrofluidic, ELectrical, Impedance): Prototyping a Point-of-Care Impedance Platelet Aggregometer. Int J Mol Sci 2020; 21:ijms21041174. [PMID: 32053940 PMCID: PMC7072796 DOI: 10.3390/ijms21041174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 01/24/2023] Open
Abstract
As key cellular elements of hemostasis, platelets represent a primary target for thrombosis and bleeding management. Currently, therapeutic manipulations of platelet function (antithrombotic drugs) and count (platelet transfusion) are performed with limited or no real-time monitoring of the desired outcome at the point-of-care. To address the need, we have designed and fabricated an easy-to-use, accurate, and portable impedance aggregometer called “MICELI” (MICrofluidic, ELectrical, Impedance). It improves on current platelet aggregation technology by decreasing footprint, assay complexity, and time to obtain results. The current study aimed to optimize the MICELI protocol; validate sensitivity to aggregation agonists and key blood parameters, i.e., platelet count and hematocrit; and verify the MICELI operational performance as compared to commercial impedance aggregometry. We demonstrated that the MICELI aggregometer could detect platelet aggregation in 250 μL of whole blood or platelet-rich plasma, stimulated by ADP, TRAP-6, collagen, epinephrine, and calcium ionophore. Using hirudin as blood anticoagulant allowed higher aggregation values. Aggregation values obtained by the MICELI strongly correlated with platelet count and were not affected by hematocrit. The operational performance comparison of the MICELI and the Multiplate® Analyzer demonstrated strong correlation and similar interdonor distribution of aggregation values obtained between these devices. With the proven reliability of the data obtained by the MICELI aggregometer, it can be further translated into a point-of-care diagnostic device aimed at monitoring platelet function in order to guide pharmacological hemostasis management and platelet transfusions.
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Solves Alcaina P. Platelet Transfusion: And Update on Challenges and Outcomes. J Blood Med 2020; 11:19-26. [PMID: 32158298 PMCID: PMC6986537 DOI: 10.2147/jbm.s234374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022] Open
Abstract
Platelet transfusion is a common practice in onco-hematologic patients for preventing or treating hemorrhages. Platelet concentrates can be transfused with therapeutic or prophylactic purposes. With the aim to help clinicians to take the decisions on platelet transfusion, some guidelines have been developed based on the current scientific evidence. However, there are some controversial issues and available scientific evidence is not enough to solve them. There is little information about what is the best platelet product to be transfused: random platelets or single donor apheresis platelets, and plasma-suspended or additive solution suspended platelets. Platelets are often transfused without respecting the ABO compatibility, but influence of this practice on platelet transfusion outcome is not well established. In the prophylactic platelet transfusion set there are some questions unsolved as the platelet threshold to transfuse prior to specific procedures or surgery, and even if platelet transfusion is necessary for some specific procedures as autologous hematopoietic stem cell transplantation. A challenging complication raised from multiple platelet transfusions is the platelet transfusion refractoriness. The study and management of this complication is often disappointing. In summary, although it is a widespread practice, platelet transfusion has still many controversial and unknown issues. The objective of this article is to review the current evidence on platelet transfusion practices, focusing on the controversial issues and challenges.
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Affiliation(s)
- Pilar Solves Alcaina
- Blood Bank, Hematology Service, Hospital Universitari I Politècnic La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
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Gottschall J, Wu Y, Triulzi D, Kleinman S, Strauss R, Zimrin AB, McClure C, Tan S, Bialkowski W, Murphy E, Ness P. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion 2019; 60:46-53. [PMID: 31850522 DOI: 10.1111/trf.15637] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the Recipient and Donor Epidemiology Study-III (REDS-III) recipient and donor databases, we performed a retrospective analysis of platelet use in 12 US hospitals that were participants in REDS-III. STUDY DESIGN AND METHODS Data were electronically extracted from participating transfusion service and blood center computer systems and from medical records of the 12 REDS-III hospitals. All platelet transfusions from 2013 to 2016 given to patients aged 18 years and older were included in the analysis. RESULTS There were 28,843 inpatients and 2987 outpatients who were transfused with 163,719 platelet products (103,371 apheresis, 60,348 whole blood derived); 93.5% of platelets were leukoreduced and 72.5% were irradiated. Forty-six percent were transfused to patients with an International Classification of Diseases, 9th/10th Revision (ICD-9/10) diagnosis of leukemia, myelodysplastic syndrome (MDS), or lymphoma. The general ward and the intensive care unit (ICU) were the most common issue locations. Only 54% of platelet transfusions were ABO identical; and 60.6% of platelet transfusions given to Rh-negative patients were Rh positive. The most common pretransfusion platelet count range for inpatients was 20,000 to 50,000/μL, for outpatients it was 10,000 to 20,000/μL. Among ICU patients, 35% of platelet transfusion episodes had a platelet count of greater than 50,000/μL; this was only 8% for general ward and 2% for outpatients. The median posttransfusion increment, not corrected for platelet dose and/or patient size, ranged from 12,000 to 20,000/μL for inpatients, and from 17,000 to 27,000/μL for outpatients. CONCLUSIONS These data from one of the largest reviews of platelet transfusion practice to date provide guidance for where to focus future clinical research studies and platelet blood management programs.
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Affiliation(s)
| | - YanYun Wu
- Bloodworks Northwest, Seattle, Washington
| | | | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald Strauss
- LifeSource/Institute for Transfusion Medicine, Chicago, Illinois
| | | | | | - Sylvia Tan
- RTI International, Raleigh, North Carolina
| | | | - Edward Murphy
- University of California San Francisco, San Francisco, California
| | - Paul Ness
- Johns Hopkins University, Baltimore, Maryland
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Baron E, Charpentier J, François A, Ben Hadj Amor H, Habr B, Cariou A, Chiche JD, Mira JP, Jamme M, Pène F. Post-transfusion platelet responses in critically ill cancer patients with hypoproliferative thrombocytopenia. Transfusion 2019; 60:275-284. [PMID: 31724828 DOI: 10.1111/trf.15596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/17/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Platelet transfusion is aimed at increasing platelet counts to prevent or treat bleeding. Critically ill cancer patients with hypoproliferative thrombocytopenia are high consumers of blood products. We herein described their post-transfusion platelet responses in the intensive care unit (ICU) and analyzed the determinants of poor post-transfusion increments. STUDY DESIGN AND METHODS This was a single-center 9-year (2009-2017) retrospective observational study. Patients with malignancies and presumed or proven hypoproliferative thrombocytopenia who had received at least one platelet transfusion in the ICU were included. Poor post-transfusion platelet increments were defined as body surface-adjusted corrected count increment (CCI) <7, or alternatively as weight-adjusted platelet transfusion recovery (PTR) <0.2. Patients were deemed refractory to platelet transfusions when two consecutive ABO-compatible transfusions resulted in poor platelet increments. RESULTS A total of 1470 platelet transfusions received by 326 patients were analyzed. Indications for platelet transfusions were distributed into prophylactic (44.5%), peri-procedural (18.1%) and therapeutic (37.4%). Regardless of indications, 54.6% and 55.4% of transfusion episodes were associated with a CCI <7 or a PTR <0.2. Factors independently associated with poor post-transfusion increments were lower body mass index, spleen enlargement, concurrent severity of clinical condition, fever ≥39°C, antibiotic therapy and increased storage duration of platelet concentrates. Eventually, 48 patients developed refractoriness to platelet transfusion, which was associated increased incidence of bleeding events. CONCLUSION Platelet transfusions are often associated with poor increments in critically ill cancer patients with hypoproliferative thrombocytopenia. The findings suggest amenable interventions to improve the platelet transfusion practices in this setting.
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Affiliation(s)
- Elodie Baron
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Julien Charpentier
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | | | - Alain Cariou
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France
| | - Jean-Daniel Chiche
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Jean-Paul Mira
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
| | - Matthieu Jamme
- Réanimation médico-chirurgicale, hôpital Poissy Saint-Germain, Poissy, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), Université Versailles Saint-Quentin, Villejuif, France
| | - Frédéric Pène
- Médecine intensive & Réanimation, Hôpital Cochin, Hôpitaux Universitaires Paris-Centre, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris Descartes, Paris, France.,Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France
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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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Refaai MA, Cahill C, Masel D, Schmidt AE, Heal JM, Kirkley SA, Blumberg N. Is It Time to Reconsider the Concepts of "Universal Donor" and "ABO Compatible" Transfusions? Anesth Analg 2019; 126:2135-2138. [PMID: 29099432 DOI: 10.1213/ane.0000000000002600] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Majed A Refaai
- From the Department of Pathology and Laboratory Medicine, Transfusion Medicine Unit, University of Rochester Medical Center, Rochester, New York
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Gavva C, Barroso J, Gernsheimer T, Metcalf RA, Warner P, Pagano MB. Response to random apheresis platelets versus HLA-selected platelets versus pooled platelets in HLA-sensitized patients. Transfusion 2019; 59:2276-2281. [PMID: 31032968 DOI: 10.1111/trf.15333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is unknown how pooled platelets (PPs) compare to random apheresis platelets (RAPs) when HLA-selected platelets (PLTs) are unavailable for HLA-sensitized patients. The aim of this study was to compare patient responses to RAPs, HLA-selected PLTs, and PPs in HLA-sensitized patients. STUDY DESIGN AND METHODS This is a single-institution retrospective study of patients from January 2014 to April 2017 with a class I calculated panel-reactive antibody of 60% or more. Response to transfusion was determined by a corrected count increment (CCI) up to 1 hour after completion of transfusion. A CCI of 5 or more was considered successful. RESULTS Seventy-seven units of RAPs, 412 units of HLA-selected PLT, and 388 units PPs were transfused. Mean CCIs when transfusing RAPs, HLA-selected PLTs, and PPs were 2.82, 11.44, and 4.77, respectively (p < 0.0001). Posttest comparison between RAPs and PPs revealed no significant difference in mean CCI while there was a significant difference between HLA-selected PLTs versus RAPs and HLA-selected PLTs versus PPs. The success rates of RAPs, HLA-selected PLTs, and PPs were 31%, 80%, and 35% respectively. There was no significant association of type of PLT and success rate when comparing RAPs versus PPs (p = 0.51) while there was a significant association between success rate and type of PLT transfusion when comparing HLA-selected PLTs with RAPs and PPs. CONCLUSION HLA-selected PLTs resulted in higher mean CCIs and more successful transfusions. There was no significant difference in mean CCI or success rate when transfusing RAPs versus PPs to HLA-sensitized patients. Future studies should assess clinical outcomes in HLA-sensitized patients receiving each type of PLT product.
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Affiliation(s)
- Chakri Gavva
- Pathology Associates of Albuquerque, Albuquerque, New Mexico.,Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington.,Bloodworks Northwest, Seattle, Washington
| | - Jeffrey Barroso
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Terry Gernsheimer
- Division of Hematology, University of Washington School of Medicine, Seattle, Washington.,Seattle Cancer Care Alliance, Seattle, Washington
| | - Ryan A Metcalf
- ARUP Laboratories, University of Utah, Salt Lake City, Utah
| | | | - Monica B Pagano
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington
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Ning S, Liu Y, Barty R, Cook R, Rochwerg B, Iorio A, Warkentin TE, Heddle NM, Arnold DM. The association between platelet transfusions and mortality in patients with critical illness. Transfusion 2019; 59:1962-1970. [DOI: 10.1111/trf.15277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/14/2019] [Accepted: 02/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Shuoyan Ning
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Yang Liu
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Rebecca Barty
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Richard Cook
- Department of Statistics and Actuarial ScienceUniversity of Waterloo Waterloo Ontario Canada
| | - Bram Rochwerg
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Impact and EvidenceMcMaster University Hamilton Ontario Canada
| | - Alfonso Iorio
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Health Research Methods, Impact and EvidenceMcMaster University Hamilton Ontario Canada
| | - Theodore E. Warkentin
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Nancy M. Heddle
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
| | - Donald M. Arnold
- Department of Medicine, Michael G. DeGroote School of MedicineMcMaster University Hamilton Ontario Canada
- Department of Medicine, McMaster Centre for Transfusion ResearchMcMaster University Hamilton Ontario Canada
- Canadian Blood Services Hamilton Ontario Canada
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40
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Nellis ME, Goel R, Karam O, Cushing MM, Davis PJ, Steiner ME, Tucci M, Stanworth SJ, Spinella PC. Effects of ABO Matching of Platelet Transfusions in Critically Ill Children. Pediatr Crit Care Med 2019; 20:e61-e69. [PMID: 30422914 PMCID: PMC6709973 DOI: 10.1097/pcc.0000000000001779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. DESIGN Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. SETTING Eighty-two PICUs in 16 countries. PATIENTS Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). CONCLUSIONS No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
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Affiliation(s)
- Marianne E Nellis
- Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Peter J Davis
- Paediatric Intensive Care Unit, Department of Pediatrics, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marie E Steiner
- Divisions of Pediatric Critical Care and Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Marisa Tucci
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Philip C Spinella
- Department of Pediatrics, Division Critical Care, Washington University in St Louis, St Louis, MO
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41
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Lin JA. Detecting No Signal From ABO Mismatch in the Quiet Riot of Platelet Transfusions in Critically Ill Children. Pediatr Crit Care Med 2019; 20:202-204. [PMID: 30720658 DOI: 10.1097/pcc.0000000000001789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- James A Lin
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Mattel Children's Hospital UCLA, University of California, Los Angeles (UCLA), Los Angeles, CA
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42
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Rajadhyaksha BS, Desai DP, Navkudkar AA. Platelet refractoriness. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_45_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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43
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Tynngård N, Boknäs N, Trinks M, Dreimane A, Berlin G. Storage-induced change in platelet transfusion response evaluated by serial transfusions from one donor to one patient. Transfusion 2018; 59:723-728. [PMID: 30548486 DOI: 10.1111/trf.15079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2018] [Accepted: 10/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Storage of platelet concentrates (PCs) results in storage lesions with possible detrimental effects on platelet recovery after transfusion, which might affect their ability to prevent or arrest bleeding. The aim of this study was to compare the quality of PCs stored for 1 to 3 or 5 to 7 days by assessing the corrected count increment (CCI) after transfusion. To isolate the effects of storage time, we studied serial transfusions of PCs obtained from one donor and one donation, and transfused to one single recipient after storage for 1 to 3 days and 5 to 7 days. STUDY DESIGN AND METHODS Platelets were obtained from one donor by apheresis, divided into two units (>240 × 109 platelets/unit) and stored for 1 to 3 and 5 to 7 days, respectively, before transfusion. The PCs were transfused on normal indications to patients undergoing treatment at the hematology ward. Platelet count was measured before and after transfusion. RESULTS Thirty patients concluded the study according to the protocol. The mean storage time was 2.4 ± 0.7 and 5.7 ± 0.8 days for platelets transfused on Days 1 to 3 and 5 to 7, respectively. Storage for 5 to 7 days decreased the 1-hour transfusion response as compared to platelets stored 1 to 3 days, from a CCI of 17 ± 7 to 13 ± 5. Despite this decrease, 86% of the 5 to 7 days stored PCs resulted in a CCI above the cutoff value for a successful transfusion of 7.5, which was not significantly different to PCs stored for 1 to 3 days. CONCLUSION Storage of PCs for 5 to 7 days only slightly altered the transfusion response.
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Affiliation(s)
- Nahreen Tynngård
- Research and Development Unit in Region Östergötland and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Niklas Boknäs
- Department of Haematology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Marie Trinks
- Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Arta Dreimane
- Department of Haematology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gösta Berlin
- Department of Clinical Immunology and Transfusion Medicine, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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44
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Aubron C, Flint AWJ, Ozier Y, McQuilten Z. Platelet storage duration and its clinical and transfusion outcomes: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:185. [PMID: 30077181 PMCID: PMC6091146 DOI: 10.1186/s13054-018-2114-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/03/2018] [Indexed: 02/08/2023]
Abstract
Background Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain. Methods We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion. We searched studies published in English between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane Libraries. Results Of the 18 studies identified, five included 4719 critically ill patients (trauma, post-cardiac surgery and a heterogeneous population of critically ill patients) and 13 included 8569 haematology patients. The five studies in critically ill patients were retrospective and did not find any association between PLT storage time when PLTs were stored for up to 5 days and mortality. There was also no association between older PLTs and sepsis in the two largest studies (n = 4008 patients). Of the 13 studies in haematology patients, seven analysed prolonged storage time up to 6.5 or 7 days. Administration of fresh PLTs (less than 2 or 3 days) was associated with a significant increase in corrected count increment (CCI) compared to older PLTs in seven of the eight studies analysing this outcome. One single centre retrospective study found an increase in bleeding events in patients receiving older PLTs. Conclusions PLT storage time does not appear to be associated with clinical outcomes, including bleeding, sepsis or mortality, in critically ill patients or haematology patients. The freshest PLTs (less than 3 days) were associated with a better CCI, although there was no impact on bleeding events, questioning the clinical significance of this association. However, there is an absence of evidence to draw definitive conclusions, especially in critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13054-018-2114-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cécile Aubron
- The Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Bvd Tanguy Prigent, 29609, Brest Cedex, France. .,The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Andrew W J Flint
- The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,Royal Australian Navy, Australian Defence Force, Canberra, Australia
| | - Yves Ozier
- The Department of Anesthesiology, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Brest, France
| | - Zoe McQuilten
- The Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,The Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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45
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Cardenas JC, Zhang X, Fox EE, Cotton BA, Hess JR, Schreiber MA, Wade CE, Holcomb JB. Platelet transfusions improve hemostasis and survival in a substudy of the prospective, randomized PROPPR trial. Blood Adv 2018; 2:1696-1704. [PMID: 30030268 PMCID: PMC6058234 DOI: 10.1182/bloodadvances.2018017699] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/12/2018] [Indexed: 01/01/2023] Open
Abstract
Transfusing platelets during massive hemorrhage is debated because of a lack of high-quality evidence concerning outcomes in trauma patients. The objective of this study was to examine the effect of platelet transfusions on mortality in severely injured trauma patients. This work analyzed PROPPR (Pragmatic, Randomized Optimal Platelet and Plasma Ratios) trial patients who received only the first cooler of blood products, which either did or did not contain platelets. Primary outcomes were all-cause mortality at 24 hours and 30 days and hemostasis. Secondary outcomes included cause of death, complications, and hospital-, intensive care unit (ICU)-, and ventilator-free days. Continuous variables were compared using Wilcoxon rank sum tests. Categorical variables were compared using Fisher's exact tests. There were 261 PROPPR patients who achieved hemostasis or died before receiving a second cooler of blood products (137 received platelets and 124 did not). Patients who received platelets also received more total plasma (median, 3 vs 2 U; P < .05) by PROPPR intervention design. There were no differences in total red blood cell transfusions between groups. After controlling for plasma volume, patients who received platelets had significantly decreased 24-hour (5.8% vs 16.9%; P < .05) and 30-day mortality (9.5% vs 20.2%; P < .05). More patients in the platelet group achieved hemostasis (94.9% vs 73.4%; P < .01), and fewer died as a result of exsanguination (1.5% vs 12.9%; P < .01). Patients who received platelets had a shorter time on mechanical ventilation (P < .05); however, no differences in hospital- or ICU-free days were observed. In conclusion, early platelet administration is associated with improved hemostasis and reduced mortality in severely injured, bleeding patients. This trial was registered at www.clinicaltrials.gov as # NCT01545232.
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Affiliation(s)
- Jessica C Cardenas
- Division of Acute Care Surgery, Department of Surgery, McGovern School of Medicine
- Center for Translational Injury Research, and
| | - Xu Zhang
- Center for Translational and Clinical Studies, University of Texas Health Science Center, Houston, TX
| | - Erin E Fox
- Division of Acute Care Surgery, Department of Surgery, McGovern School of Medicine
- Center for Translational Injury Research, and
- Center for Translational and Clinical Studies, University of Texas Health Science Center, Houston, TX
| | - Bryan A Cotton
- Division of Acute Care Surgery, Department of Surgery, McGovern School of Medicine
- Center for Translational Injury Research, and
- Center for Translational and Clinical Studies, University of Texas Health Science Center, Houston, TX
| | - John R Hess
- Department of Laboratory Medicine, Harborview Medical Center, University of Washington, Seattle, WA; and
| | - Martin A Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Charles E Wade
- Division of Acute Care Surgery, Department of Surgery, McGovern School of Medicine
- Center for Translational Injury Research, and
- Center for Translational and Clinical Studies, University of Texas Health Science Center, Houston, TX
| | - John B Holcomb
- Division of Acute Care Surgery, Department of Surgery, McGovern School of Medicine
- Center for Translational Injury Research, and
- Center for Translational and Clinical Studies, University of Texas Health Science Center, Houston, TX
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46
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Humbrecht C, Kientz D, Gachet C. Platelet transfusion: Current challenges. Transfus Clin Biol 2018; 25:151-164. [PMID: 30037501 DOI: 10.1016/j.tracli.2018.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 12/29/2022]
Abstract
Since the late sixties, platelet concentrates are transfused to patients presenting with severe thrombocytopenia, platelet function defects, injuries, or undergoing surgery, to prevent the risk of bleeding or to treat actual hemorrhage. Current practices differ according to the country or even in different hospitals and teams. Although crucial advances have been made during the last decades, questions and debates still arise about the right doses to transfuse, the use of prophylactic or therapeutic strategies, the nature and quality of PC, the storage conditions, the monitoring of transfusion efficacy and the microbiological and immunological safety of platelet transfusion. Finally, new challenges are emerging with potential new platelet products, including cold stored or in vitro produced platelets. The most debated of these points are reviewed.
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Affiliation(s)
- C Humbrecht
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France.
| | - D Kientz
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France
| | - C Gachet
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France.
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47
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Ng MSY, Tung JP, Fraser JF. Platelet Storage Lesions: What More Do We Know Now? Transfus Med Rev 2018; 32:S0887-7963(17)30189-X. [PMID: 29751949 DOI: 10.1016/j.tmrv.2018.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/09/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
Platelet concentrate (PC) transfusions are a lifesaving adjunct to control and prevent bleeding in cancer, hematologic, surgical, and trauma patients. Platelet concentrate availability and safety are limited by the development of platelet storage lesions (PSLs) and risk of bacterial contamination. Platelet storage lesions are a series of biochemical, structural, and functional changes that occur from blood collection to transfusion. Understanding of PSLs is key for devising interventions that prolong PC shelf life to improve PC access and wastage. This article will review advancements in clinical and mechanistic PSL research. In brief, exposure to artificial surfaces and high centrifugation forces during PC preparation initiate PSLs by causing platelet activation, fragmentation, and biochemical release. During room temperature storage, enhanced glycolysis and reduced mitochondrial function lead to glucose depletion, lactate accumulation, and product acidification. Impaired adenosine triphosphate generation reduces platelet capacity to perform energetically demanding processes such as hypotonic stress responses and activation/aggregation. Storage-induced alterations in platelet surface proteins such as thrombin receptors and glycoproteins decrease platelet aggregation. During storage, there is an accumulation of immunoactive proteins such as leukocyte-derive cytokines (tumor necrosis factor α, interleukin (IL) 1α, IL-6, IL-8) and soluble CD40 ligand which can participate in transfusion-related acute lung injury and nonhemolytic transfusion reactions. Storage-induced microparticles have been linked to enhanced platelet aggregation and immune system modulation. Clinically, stored PCs have been correlated with reduced corrected count increment, posttransfusion platelet recovery, and survival across multiple meta-analyses. Fresh PC transfusions have been associated with superior platelet function in vivo; however, these differences were abrogated after a period of circulation. There is currently insufficient evidence to discern the effect of PSLs on transfusion safety. Various bag and storage media changes have been proposed to reduce glycolysis and platelet activation during room temperature storage. Moreover, cryopreservation and cold storage have been proposed as potential methods to prolong PC shelf life by reducing platelet metabolism and bacterial proliferation. However, further work is required to elucidate and manage the PSLs specific to these storage protocols before its implementation in blood banks.
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Affiliation(s)
- Monica Suet Ying Ng
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John-Paul Tung
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Research and Development, Australian Red Cross Blood Service, Kelvin Grove, Queensland, Australia.
| | - John Francis Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
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48
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Fernández-Muñoz H, Plaza EM, Rivera-Caravaca JM, Candela MJ, Romera M, De Arriba F, Lozano ML, Vicente V, Heras I, Castilla-Llorente C, Rivera J. Comparative assessment of prophylactic transfusions of platelet concentrates obtained by the PRP or buffy-coat methods, in patients undergoing allogeneic hematopoietic stem cell transplantation. ACTA ACUST UNITED AC 2018; 23:712-718. [PMID: 29582705 DOI: 10.1080/10245332.2018.1455434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Whole blood-derived platelet concentrates can be obtained by the platelet-rich plasma (PRP-PCs) or the buffy-coat (BC-PCs) method. Few studies have shown that BC-PCs display lower in vitro platelet activation, but scarce information exists regarding transfusion efficacy. We have performed a retrospective study assessing platelet transfusion in patients undergoing allogeneic hematopoietic cell transplantation (AHCT) in our clinic, before and after the implementation of BC-PCs. METHODS We reviewed clinical records corresponding to 70 PRP-PCs and 86 BC-PCs prophylactic transfusions, which were performed to 55 AHCT patients. Transfusion efficacy was assessed by the 24-h post-transfusion corrected count increment (24-h CCI) and bleeding events. Clinical factors affecting transfusion outcome were also investigated. RESULTS Clinical characteristics and the total number of platelet transfusions were similar among groups. Mean donor exposure was 5.8 and 5.0 in each single PRP-PCs and BC-PCs transfusion, respectively (p < 0.01). The 24-h CCI was significantly higher in patients transfused with BC-PCs than in those receiving PRP-PCs (8.3[2.7-13.4] vs. 4.7[1.3-8.1]; p < 0.01). Independent predictors of poor platelet transfusion response included diagnosis other than acute leukemia (HR 8.30; 95% CI 1.96-35.22; p = 0.004), splenomegaly (HR 8.75; 95% CI 2.77-27.60; p < 0.001), graft versus host disease prophylaxis different from cyclosporine A and methotrexate (HR 3.96; 95% CI 1.55-10.14; p = 0.004) and PRP-PCs transfusion (HR 4.54; 95% CI 1.72-12.01; p = 0.002). There were no differences between both groups regarding the bleeding events. CONCLUSION In the AHCT setting, we hypothesize that BC-PCs transfusion, when compared to PRP-PCs, results in higher CCI and reduced donor exposure, but provides no significant benefit regarding bleeding outcome.
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Affiliation(s)
- Hermógenes Fernández-Muñoz
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain.,b Servicio de Hematología y Hemoterapia , Hospital Universitario Rafael Méndez , Lorca , Spain
| | - Eva M Plaza
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - José Miguel Rivera-Caravaca
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - María José Candela
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - Marta Romera
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain.,c Servicio de Hematología y Hemoterapia , Hospital Universitario Santa Lucía , Cartagena , Spain
| | - Felipe De Arriba
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - María L Lozano
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - Vicente Vicente
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - Inmaculada Heras
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
| | - Cristina Castilla-Llorente
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain.,d Service d' Hématologie , Institut Gustave Roussy , Villejuif , France
| | - José Rivera
- a Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguer, Centro Regional de Hemodonación , Universidad de Murcia, CIBERER, IMIB-Arrixaca , Murcia , Spain
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49
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Seigeot A, Desmarets M, Rumpler A, Leroux F, Deconinck E, Monnet E, Bardiaux L. Factors related to the outcome of prophylactic platelet transfusions in patients with hematologic malignancies: an observational study. Transfusion 2018. [PMID: 29542122 DOI: 10.1111/trf.14592] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND A better knowledge of the connections between platelet concentrate (PC) characteristics and transfusion outcomes in day-to-day practice would help improve the selection process of the most appropriate PC. STUDY DESIGN AND METHODS In this study of prophylactic platelet transfusions in patients with hematologic malignancies between 2002 and 2012, outcome criteria were corrected count increments (CCIs) and platelet transfusion intervals (TIs, in days). Studied characteristics were ABO matching status, platelet source, dose, storage duration, irradiation, washing, and transfusion sequence number (TSN). The analysis consisted of multivariable linear mixed-effects models with adjustments for patient diagnosis, sex, and type of treatment. RESULTS Overall, 869 patients and 6662 platelet transfusions were analyzed. For each day after the second day of storage, the CCI and TI decreased by 0.88 and 0.06 day, respectively. Compared to ABO-identical, transfusion with major ABO-incompatible PCs decreased the CCI and TI by 0.79 and 0.21 day, respectively. Platelet washing reduced the CCI and TI by 2.28 and 0.24 day, respectively. There was no significant association between platelet source or irradiation and CCI or TI. TI increased as the platelet dose per kg increased. Both CCI and TI decreased as the TSN increased. CONCLUSION Transfusion outcomes were significantly related to several PC-related factors. Associations for ABO matching status and storage duration were stronger than previously reported. Taking into account such factors when selecting a PC for transfusion could be beneficial to the recipient.
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Affiliation(s)
- Audrey Seigeot
- Etablissement Français du Sang Bourgogne-Franche-Comté, Dijon, France
| | | | | | - Franck Leroux
- CHRU Besançon, Centre d'Investigation Clinique Inserm CIC1431
| | - Eric Deconinck
- CHRU Besançon, Service d'Hématologie Clinique.,Inserm UMR1098, Etablissement Français du Sang, Université Bourgogne-Franche-Comté
| | - Elisabeth Monnet
- CHRU Besançon, Centre d'Investigation Clinique Inserm CIC1431.,Université Bourgogne Franche-Comté, EA4266 Agents Pathogènes et Inflammation, Besançon, France
| | - Laurent Bardiaux
- Inserm UMR1098, Etablissement Français du Sang, Université Bourgogne-Franche-Comté.,Etablissement Français du Sang Pyrénées Méditerranée, Toulouse, France
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50
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Sut C, Tariket S, Aubron C, Aloui C, Hamzeh-Cognasse H, Berthelot P, Laradi S, Greinacher A, Garraud O, Cognasse F. The Non-Hemostatic Aspects of Transfused Platelets. Front Med (Lausanne) 2018. [PMID: 29536007 PMCID: PMC5835084 DOI: 10.3389/fmed.2018.00042] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves. The involvement of PCs in SARs—particularly on a critically ill patient’s context—could be related, at least in part, to the inflammatory functions of platelets, acquired during storage lesions. Moreover, we focus on causal link between platelet activation and immune-mediated disorders (transfusion-associated immunomodulation, platelets, polyanions, and bacterial defense and alloimmunization). This is linked to the platelets’ propensity to be activated even in the absence of deliberate stimuli and to the occurrence of time-dependent storage lesions.
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Affiliation(s)
- Caroline Sut
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France.,Etablissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Sofiane Tariket
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France.,Etablissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Cécile Aubron
- Médecine Intensive Réanimation, Centre Hospitalier Régionale et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Chaker Aloui
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France
| | | | | | - Sandrine Laradi
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France.,Etablissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
| | - Andreas Greinacher
- Institute for Immunology and Transfusion Medicine, University of Greifswald, Greifswald, Germany
| | - Olivier Garraud
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France.,Institut National de Transfusion Sanguine (INTS), Paris, France
| | - Fabrice Cognasse
- GIMAP-EA3064, Université de Lyon, Saint-Étienne, France.,Etablissement Français du Sang, Auvergne-Rhône-Alpes, Saint-Etienne, France
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