A randomized controlled trial comparing the frequency of acute reactions to plasma‐removed platelets and prestorage WBC‐reduced platelets

Heddle, Nancy M.; Blajchman, Morris A.; Meyer, Ralph M.; Lipton, Jeff H.; Walker, Irwin; Sher, Graham D.; Constantini, Lorrie A.; Patterson, Bruce; Roberts, Robin S.; Thorpe, Kevin E.; Levine, Mark

doi:10.1046/j.1537-2995.2002.00094.x

Cited by 194 publications

(189 citation statements)

References 35 publications

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“…35 In the current investigation it was not possible to study another important potential benefit of prestorage leukoreduction (ie, a reduction in FNHTRs) since the method of recording these events at our center changed over the study period. [36][37][38][39][40] Similarly, the other predicted advantages of prestorage leukoreduction, such as a reduction in transfusion-associated infections and posttransfusion immune suppression, require further study. [41][42][43][44] If these benefits are confirmed they will add support to the results of this study and the growing body of literature in favor of prestorage leukoreduction.…”

Section: Discussionmentioning

confidence: 99%

Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

Seftel

Growe

Petraszko

et al. 2004

Blood

126

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Randomized controlled trials have shown a reduction in platelet alloimmunization and refractoriness in patients with acute leukemia (AL) with the use of poststorage leukoreduction of blood products. Universal prestorage leukoreduction (ULR) of red cell and platelet products has been performed in Canada since August 1999. We conducted a retrospective analysis of 13 902 platelet transfusions in 617 patients undergoing chemotherapy (CT) for AL or stem cell transplantation (SCT) before (n ‫؍‬ 315) and after (n ‫؍‬ 302) the introduction of ULR. Alloimmunization was significantly reduced (19% to 7%, P < .001) in the post-ULR group. Alloimmune platelet refractoriness was similarly reduced (14% to 4%, P < .001). Fewer patients in the post-ULR group received HLA-matched platelets (14% vs 5%, P < .001). Alloimmunization and alloimmune refractoriness in the 318 patients who were previously pregnant and/or transfused were also reduced after ULR (P ‫؍‬ .023 and P ‫؍‬ .005, respectively). In a Cox regression model, the 3 independent factors that predicted for alloimmune refractoriness were nonleukoreduced blood

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Section: Discussionmentioning

confidence: 99%

Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

Seftel

Growe

Petraszko

et al. 2004

Blood

126

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“…The relationship between bleeding and thrombocytopenia has been well described, and bleeding is a frequent complication occurring in this patient population. [1][2][3][4][5][6][7][8] Despite the administration of prophylactic or therapeutic platelet (PLT) transfusions, these patients are still at risk of bleeding.…”

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confidence: 99%

A multicenter pilot‐randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukemia or stem cell transplantation

et al. 2007

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BACKGROUND:Anemia may be an important factor contributing to an increased risk of bleeding, particularly in patients with thrombocytopenia. STUDY DESIGN AND METHODS:A multicenter, single-blinded pilot randomized controlled trial (RCT) was performed to evaluate the feasibility of conducting a larger RCT to determine the effect of the hemoglobin (Hb) concentration on bleeding risk. Patients with acute leukemia receiving induction chemotherapy or those undergoing stem cell transplantation were assigned to one of two treatment groups: standard transfusion strategy (transfusion of 2 units of red blood cells [RBCs] when their Hb level was less than 80 g/L) or an augmented transfusion strategy (transfusion of 2 units of RBCs when their Hb level was less than 120 g/L). RESULTS: Sixty patients were enrolled: 29 in the control group and 31 in the experimental group. The proportions of patients experiencing clinically significant bleeding and the time to first bleed were not significantly different between the control and experimental groups. The experimental group received more RBC transfusions (transfusions/patient-day) than the control group (0.233 vs. 0.151; relative risk, 1.56; 95% confidence interval, 1.16-2.10; p = 0.003). The proportion of patient-days with platelet (PLT) transfusions was not different between the experimental and control groups. The mean number of donor exposures (PLT and RBC transfusions) was not different between experimental and control groups. Bleeding symptoms were systematically documented. CONCLUSION: This pilot study thus indicated that it would be feasible to enroll the required number of patients to enable the performance of a large RCT to investigate the effect of Hb on bleeding risk in thrombocytopenic patients. P atients with acute leukemia undergoing induction chemotherapy or patients undergoing stem cell transplantation (SCT) often have prolonged thrombocytopenia both because of the cytotoxic therapies they receive and because of their underlying disorders. The relationship between bleeding and thrombocytopenia has been well described, and bleeding is a frequent complication occurring in this patient population.1-8 Despite the administration of prophylactic or therapeutic platelet (PLT) transfusions, these patients are still at risk of bleeding.Experimental evidence in animal models suggests that the hemoglobin (Hb) concentration may play a role in determining the bleeding risk in patients with thrombocytopenia. In contrast, other groups have suggested that ABBREVIATIONS: AML = acute myeloid leukemia; RCT(s) = randomized controlled trial(s); RR(s) = relative risk(s). acute hemodilution may increase coagulation. 9,10 With a thrombocytopenic rabbit model, Blajchman and coworkers 11 demonstrated the bleeding time to be inversely correlated with the hematocrit (Hct). This study showed that increasing the red blood cell (RBC) mass by RBC transfusion partially corrected the bleeding time in thrombocytopenic anemic rabbits. The reasons for this are not clearly understood, but several mec...

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“…It has been reported that cytokine levels are more in PC stored at 22°C than in red cells stored at 4°C because higher temperature may allow greater metabolic activity of cytokine producing WBCs. Heddle et al [16] demonstrated this by separating cellular and plasma or supernatant portion of PCs. It was shown that most reactions to platelets were caused by WBC derived cytokines that accumulate in the plasma portion of the component.…”

Section: Discussionmentioning

confidence: 97%

“…According to them the release of cytokines from dead WBCs is also possible as they showed that IL-8 mRNA levels increased from Day 1 to Day 8 using semi quantitative RT-PCR. Heddle et al [16] demonstrated that if WBC counts are reduced to a concentration lower than 5 9 10 6 /unit the cytokine release is reduced . Different studies have adopted different techniques for leukoreduction.…”

Section: Discussionmentioning

confidence: 99%

Time Dependent Release of Interleukin-8 and Tumor Necrosis Factor-α in Platelet Concentrate

Shukla

Patel

Gupte

2014

Indian J Hematol Blood Transfus

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Contaminating white blood cells in stored platelet concentrate (PC) are the source of many pro-inflammatory cytokines. These are implicated in transfusion reactions. To study the release of interleukin (IL)-8 and tumor necrosis factor alpha (TNF-a) at different time interval in PC prepared byplatelet rich plasma (PRP) and buffy coat (BC) using different principles. Fifteen PCs were prepared by both the methods. The supernatants of PCs prepared by PRP and BC methods were collected aseptically after 1, 18, 65 and 112 h of preparation. pH, platelet and WBC counts were done. The supernatants were frozen in aliquots at -56°C for measurement of IL-8 and TNF-a concentration using ELISA. The Mean ± SD value of WBC in PRP-PC was 7.4 ± 3.75 9 10 7 and in BC-PC 3.9 ± 2.2 9 10 7

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A randomized controlled trial comparing the frequency of acute reactions to plasma‐removed platelets and prestorage WBC‐reduced platelets

Cited by 194 publications

References 35 publications

Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

Universal prestorage leukoreduction in Canada decreases platelet alloimmunization and refractoriness

A multicenter pilot‐randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukemia or stem cell transplantation

Time Dependent Release of Interleukin-8 and Tumor Necrosis Factor-α in Platelet Concentrate

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