A pilot study to assess the hemostatic function of pathogen‐reduced platelets in patients with thrombocytopenia

Johansson, Pär I.; Simonsen, Anne Catrine; Brown, Peter N.; Ostrowski, Sisse Rye; Deberdt, Liesbeth; Hoydonck, Pascale Van; Yonemura, Susan; Goodrich, Raymond P.

doi:10.1111/trf.12055

Cited by 17 publications

(68 citation statements)

References 49 publications

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“…In single‐blind crossover studies, in vivo recovery and survival of PRT‐treated PCs were reduced compared with those of untreated control units, as evidenced by reduced corrected count increment . However, the results of a recent pilot study of PLT function in PRT‐treated PLTs isolated from the circulation of patients after transfusion have suggested that these circulating cells may elicit hemostatic responses comparable to those in untreated PLTs . To develop strategies that minimize the negative effects of PRT, it is necessary to determine the mechanisms by which PLTs are damaged.…”

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confidence: 99%

Effects of riboflavin and ultraviolet light treatment on platelet thrombus formation on collagen via integrin αIIbβ3 activation

et al. 2014

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confidence: 99%

Effects of riboflavin and ultraviolet light treatment on platelet thrombus formation on collagen via integrin αIIbβ3 activation

et al. 2014

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“…Its use in hematology-oncology patients with thrombocytopenia is relatively novel, but interest is growing [8,28]. We found that both gamma-irradiated and untreated PCs significantly improved all TEG variables within 1 h of transfusion, indicating that the transfused PLTs were hemostatically active and that TEG was sensitive to the effects of a single PLT transfusion.…”

Section: Discussionmentioning

confidence: 79%

“…Despite the small sample size, it is clear that TEG measurements demonstrated a hemostatic effect due to PLT transfusion in hematology-oncology patients with thrombocytopenia, and MA results were consistent with PLT counts. However, a common criticism of TEG is that it has not been correlated with more clinically relevant outcome measures such as bleeding events [8]. Apelseth et al [18] recently reported that MA measured by TEG correlates with PLT CIs and bleeding, thus reflecting both PLT viability and functionality in hematology-oncology patients and demonstrating TEG's clinical utility in this patient population.…”

Section: Discussionmentioning

confidence: 99%

“…The utility of TEG to provide rapid assessments of global hemostatic function in the operating theater and the emergency room is well established, and clot strength has repeatedly been reported to have the best correlation with clinically relevant blood loss [8,25,26,27]. Its use in hematology-oncology patients with thrombocytopenia is relatively novel, but interest is growing [8,28].…”

Section: Discussionmentioning

confidence: 99%

“…In general, hemostatic status has been monitored with plasma-based coagulation tests such as PT/INR and APTT, which underestimate coagulopathy [7]. Moreover, these tests are insensitive for hypocoagulant conditions and thus may be of limited value for the detection of impaired coagulation activity upon dilution [8,9,10]. Recent studies have shown that hemostatic function after transfusion of apheresis platelet concentrates (PCs) as assessed by whole blood tests (thrombelastography (TEG)).…”

Section: Introductionmentioning

confidence: 99%

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Hemostatic Function and Transfusion Efficacy of Apheresis Platelet Concentrates Treated with Gamma Irradiation in Use for Thrombocytopenic Patients

Zhu

Wang

et al. 2014

Transfus Med Hemother

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Background: During the transfusion of blood components, the transfer of allogeneic donor white blood cells (WBCs) can mediate transfusion-associated graft-versus-host disease (TA-GVHD). To minimize the reaction, exposure of blood products to gamma irradiation is currently the standard of care. The aim of our study was to evaluate and compare hemostatic function, transfusion efficacy, and safety of gamma-irradiated single-donor apheresis platelet concentrates (PCs) and of conventional non-irradiated PCs in patients with chemotherapy-induced thrombocytopenia. Methods: 20 double-dose single-donor leukoreduced PCs were split in two identical units; one was gamma-irradiated with 25 Gy (study arm A) and the other remains non-irradiated (study arm B). Both units were stored under equal conditions. Hematologic patients were randomly assigned to receive gamma-irradiated or conventional non-irradiated PCs. Hemostatic function was evaluated by thrombelastography (TEG). TEG measurements were taken pre transfusion and 1 and 24 h post transfusion. TEG profiles were measured, noting the time to initiate clotting (R), the angle of clot formation (α), and the maximum amplitude (clot strength (MA)). Whole blood samples were collected from these thrombocytopenic patients at 1 and 24 h for PLT count increments (CIs) and corrected count increments (CCIs) with assessments of transfusion efficacy. Time to next PLT transfusion, transfusion requirement of RBCs, active bleeding, and adverse events (AEs), were analyzed. Results: No differences could be found in hemostatic function parameters (MA, R, and α) between study arms A and B (all p values > 0.096) pre transfusion as well as 1 and 24 h post transfusion. No differences between study arms A and B were observed for mean (± standard deviation (SD)) 1-hour CCI (12.83 ± 6.33 vs. 11.59 ± 5.97) and 24-hour CCI (6.56 ± 4.10 vs. 5.76 ± 4.05). Mean 1-hour CI and 24-hour CI were not significantly different in both study arms (p = 0.254 and p = 0.242 respectively). Median time to the next PC transfusion after study PC was not significantly different between groups: (2.4 vs. 2.2 days, p = 0.767). No differences could be found in transfusion requirement of red blood cells (p = 0.744) between both study arms. There were also no regarding bleeding, adverse events, and acute transfusion reaction(s). Conclusions: This study confirms safety of gamma-irradiated PCs for treatment thrombocytopenia. Hemostatic function, transfusion efficacy, bleeding, and safety of single-donor apheresis PCs treated with gamma irradiation versus untreated control PCs are comparable.

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Pathogen-reduced platelets for the prevention of bleeding

Estcourt

Malouf

Hopewell

et al. 2017

Cochrane Database of Systematic Reviews

117

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Background Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak. One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets. This is an update of a Cochrane review first published in 2013. Objectives To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. Selection criteria We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another. Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials). One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other...

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A pilot study to assess the hemostatic function of pathogen‐reduced platelets in patients with thrombocytopenia

Cited by 17 publications

References 49 publications

Effects of riboflavin and ultraviolet light treatment on platelet thrombus formation on collagen via integrin αIIbβ3 activation

Effects of riboflavin and ultraviolet light treatment on platelet thrombus formation on collagen via integrin αIIbβ3 activation

Hemostatic Function and Transfusion Efficacy of Apheresis Platelet Concentrates Treated with Gamma Irradiation in Use for Thrombocytopenic Patients

Pathogen-reduced platelets for the prevention of bleeding

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