Alternatives to allogeneic platelet transfusion

Abstract

Allogeneic platelet transfusions are widely used for the prevention and treatment of bleeding in thrombocytopenia. Recent evidence suggests platelet transfusions have limited efficacy and are associated with uncertain immunomodulatory risks and concerns about viral or bacterial transmission. Alternatives to transfusion are a well-recognised tenet of Patient Blood Management, but there has been less focus on different strategies to reduce bleeding risk by comparison to platelet transfusion. Direct alternatives to platelet transfusion include agents to stimulate endogenous platelet production (thrombopoietin mimetics), optimising platelet adhesion to endothelium by treating anaemia or increasing von Willebrand factor levels (desmopressin), increasing formation of cross-linked fibrinogen (activated recombinant factor VII, fibrinogen concentrate or recombinant factor XIII), decreasing fibrinolysis (tranexamic acid or epsilon aminocaproic acid) or using artificial or modified platelets (cryopreserved platelets, lyophilised platelets, haemostatic particles, liposomes, engineered nanoparticles or infusible platelet membranes). The evidence base to support the use of these alternatives is variable, but an area of active research. Much of the current randomised controlled trial focus is on evaluation of the use of thrombopoietin mimetics and anti-fibrinolytics. It is also recognised that one alternative strategy to platelet transfusion is choosing not to transfuse at all.

Comparison between manufacturing sites shows differential adhesion, activation, and GPIbα expression of cryopreserved platelets

“…The demand for platelet concentrates (PCs) has increased progressively over the years due to an aging population and an increased number of patients suffering from chronic thrombocytopenia. Platelets (PLTs) are transfused for prophylaxis in patients with hematologic malignancies or to treat active bleeding .…”

Platelets and infections in the resource‐limited countries with a focus on malaria and viral haemorrhagic fevers

“…Avoiding prophylactic platelet transfusions and anticipating bleeding risks are therefore key considerations. Simple measures like antacids for severely ill patients to prevent potential gastrointestinal haemorrhage, hormonal preparations for women who are likely to have periods and supplementation of vitamins including vitamin K are simple measures (Desborough et al , ). Tranexamic acid is a cheap alternative to platelet transfusion if the patient has mucosal bleeding.…”

“…Also refrigeration of whole blood will cause rapid removal of transfused platelets by the reticuloendothelial system. Research into refrigerated or lyophilised platelets or platelet substitutes is encouraging but do require support from the relevant pharmaceutical industry to subsidise their use in the emerging nations (Desborough et al , ).…”

Impact of implementing pathogen reduction technologies for platelets on reducing outdates

“…In the case of platelet concentrates (PC), it is hard to meet these goals for several reasons. Their short shelf life (a maximum of 5 days, extendable to seven if a bacterial detection method is used or they are treated with a pathogen reduction technology ) and growing demand due to an ageing population and increasingly aggressive pharmacological treatments .…”