Efficacy of prophylactic transfusions using single donor apheresis platelets versus pooled platelet concentrates in AML/MDS patients receiving allogeneic hematopoietic stem cell transplantation

Superiority of single-donor apheresis platelets (SDAP) over pooled platelet concentrates (PPC) transfusions is largely assumed, but unproven. We hypothesized that prophylactic SDAP and PPC transfusions are clinically equivalent after allogeneic hematopoietic stem cell transplants (HSCT). We studied all transfusions administered to 33 patients with AML/MDS during the first 100 days after busulfan-based, myeloablative HSCT. All donor-recipient pairs were ABO identical. Transfusion threshold was a platelet count < or =15 x 10(9)/l. The corrected increment (CCI) was used for all comparisons. Median time to platelet engraftment was 13 days (n=30). PPC transfusions (n=105) were ABO compatible, while 10% of 41 SDAP were not (P=0.006). Median post-transfusion platelet count was 51K/microl (5-118K) after SDAP and 36K/microl (3-115K) after PPC (P=0.0004). Median CCI was 14.178 (SDAP) versus 7.793 (PPC) (P=0.0001). Median time to another transfusion was 3 days (SDAP) and 2 days (PPC; P=0.3). In the week following any given transfusion, the median number of new transfusions was similar (n=2), as well as the need of further transfusion (16 versus 24%, P=0.2). A total of 17% of SDAP and 30% of PPC transfusions were labeled 'ineffective' (P=0.1). There were two non-lethal hemorrhage episodes (6%). SDAP transfusions produced better platelet counts, but SDAP and PPC were equally effective in preventing hemorrhage.

Microbial contamination of hematopoietic progenitor cell products: clinical outcome

We reviewed the results of routine microbiological assays of 3078 infused hematopoietic progenitor cell (HPC) products for autologous and allogeneic transplantation between January 2001 and December 2005. Thirty-seven (1.2%) contaminated products were found. All patients receiving contaminated infusions received empirical antibiotic prophylaxis according to the assay result. None of these patients developed a positive blood culture with the same agent, developed infections that could be attributable to the contaminated product or experienced any clinical sequelae. Coagulase-negative Staphylococcus was found in 32 (86.5%) products. Admission lengths and time to engraftment were within the expected time frame for autologous and allogeneic transplants. Microbial contamination of HPC products occurs at a low frequency; prophylactic use of antibiotics based on the microbiological assay appears to be effective in preventing clinical complications.