Age of platelet concentrates and time to the next transfusion

Abstract

BACKGROUND Storage time of platelet (PLT) concentrates has been negatively associated with clinical efficacy outcomes. The aim of this study was to quantify the association between storage time of PLT concentrates and interval to the next PLT transfusion for different types of PLT components, stored for up to 7 days and transfused to transfusion‐dependent hematooncology patients with thrombocytopenia. STUDY DESIGN AND METHODS From a cohort of patients from 10 major Dutch hospitals, patients were selected whose transfusion patterns were compatible with PLT transfusion dependency due to hematooncologic disease. Mean time to the next transfusion and mean differences in time to the next transfusion for different storage time categories (i.e., fresh, <4 days; intermediate, 4‐5 days; and old, >5 days) were estimated, per component type, using multilevel mixed‐effects linear models. RESULTS Among a cohort of 29,761 patients who received 140,896 PLT transfusions we selected 4441 hematooncology patients who had received 12,724 PLT transfusions during periods of PLT transfusion dependency. Transfusion of fresh, compared to old, buffy coat–derived PLTs in plasma was associated with a delay to the next transfusion of 6.2 hours (95% confidence interval [CI], 4.5‐8.0 hr). For buffy coat–derived PLTs in PAS‐B and ‐C this difference was 7.7 hours (95% CI, 2.2‐13.3 hr) and 3.9 hours (95% CI, –2.1 to 9.9 hr) while for apheresis PLTs in plasma it was only 1.8 hours (95% CI, –3.5 to 7.1 hr). CONCLUSION Our results indicate that the time to the next transfusion shortens with increasing age of transfused buffy coat–derived PLT concentrates. This association was not observed for apheresis PLTs.

Post‐transfusion platelet responses in critically ill cancer patients with hypoproliferative thrombocytopenia

“…Several observational studies in non-critically ill hematology patients reported improved post-transfusion increments when using fresh platelet concentrates stored for less than 3 days, though without any significant impact on the further incidence of bleeding events. [27][28][29][30][31] Finally, how may the present findings translate into improvement in platelet transfusion practices in the ICU? Few factors are likely amenable to specific interventions to improve the efficacy of transfusions, by increasing the dose of transfused platelets, and maybe controlling fever and avoiding thrombocytotoxic antibiotics.…”

“…Storage of platelet concentrates is limited to 5 days in France, and up to 7 days in other parts of the world, in order to prevent the development of storage lesions including bacterial proliferation and release of bioreactive substances. Several observational studies in non‐critically ill hematology patients reported improved post‐transfusion increments when using fresh platelet concentrates stored for less than 3 days, though without any significant impact on the further incidence of bleeding events …”

Platelet Additive Solutions: A Review of the Latest Developments and Their Clinical Implications

“…For a long time, it was true that PAS-stored platelets had a lower increment than plasma-stored ones. However, the reformulation of PAS-B to PAS-C already was a major improvement, for example prompting the Netherlands moving from 5-to 7-day storage of platelets in PAS [19]. This was based on the randomized clinical trial by Kerkhoffs et al [20], that studied transfusion efficacy in hemato-oncological patients, revealing that buffy coat-derived platelets in plasma, stored for up to 7 days after collection, had a 1-hour CCI of 17.1 ± 7.3, while those stored in PAS-C had a CCI of 15.3 ± 6.5, i.e.…”