Delayed alloimmunization using random single donor platelet transfusions: a prospective study in thrombocytopenic patients with acute leukemia

Abstract

A randomized study was performed in 54 thrombocytopenic patients with acute leukemia. Alloimmunization of recipients of random multiple-donor platelet concentrates (MD group) was compared to that of patients receiving random single-donor platelets (SD group). In the SD patients, formation of alloantibodies (mostly anti-HLA) occurred less frequently (p less than 0.002), after a longer time period (p less than 0.002), and after a higher number of transfusions (p less than 0.005) as compared to MD patients. SD patients also became refractory to random platelets less frequently (p less than 0.005), after a longer time period, and after a higher number of transfusions (p less than 0.02). In SD patients, the increments after the first and the last transfusion were in the same range, whereas in MD patients, the 1-hr (p less than 0.001) and the 24-hr (p less than 0.025) increments decreased from the first to the last transfusion. Thus, the use of random SD platelet transfusions postponed alloimmunization.

Buffy-coat-derived pooled platelet concentrates and apheresis platelet concentrates: which product type should be preferred?

“…Several studies directly compared corrected count increments (CCI) after transfusion of apheresis or whole blood‐derived platelets [27–33]. In a systematic comparison on the basis of raw data from some of these studies [27–31], Heddle et al. found a higher 1‐h CCI with apheresis PC compared with all whole blood‐derived PCs when PRP and BC‐derived PCs were combined.…”

“…Several studies addressed whether transfusing only apheresis PCs can prevent alloimmunization as measured by lymphocytotoxic antibodies and refractoriness as defined by poor posttranfusion increments [29,30,75]. In a metaanalysis combining studies that used non‐leukoreduced products, the overall relative risk for allosensitization was not significantly different between apheresis PCs and pooled whole blood‐derived PCs [34].…”

The value of evidence‐based medicine

“…We have recently performed a systematic review to address this question [5]. Using a systematic approach for searching the scientific literature, we identified 10 RCTs that compared one or more of the platelet products for the outcomes of: acute reactions, alloimmunization, refractoriness, bleeding, time to next transfusion, corrected count increments, and radiolabelled recovery and survival [6–15]. The 10 relevant studies enrolled a total of 1137 patients who received a total of 11 575 platelet transfusions (7629 platelets from PRP, 576 platelets from buffy‐coats and 3370 apheresis platelets).…”

The top ten list of randomized controlled trials in transfusion medicine

“…Over this period, less than 100 randomized controlled trials have been done to evaluate the various Transfusion Medicine interventions used in the treatment of patients [8–72]. The focus of these randomized controlled trials have ranged widely from: studying the efficacy of platelets for the treating thrombocytopenic bleeding; evaluating the use of pathogen reduction technology on platelets to prevent bleeding in thrombocytopenic subjects; the evaluation of leucoreduction in preventing transfusion‐related immunomodulatory effects; evaluating transfusion triggers for both red blood cells or platelets; assessing the efficacy of various infectious disease markers in preventing transfusion‐transmitted infections; evaluating the role of various agents in reducing allogeneic transfusion requirements; or studying the role of allogeneic red blood cell transfusions and the postoperative length of stay at a hospital, or intensive care site [8–72].…”

“…Many of the Transfusion Medicine related reported randomized controlled trials that have been done over the past decade are listed in the references [8–72]. During the presentation, the author will present his ‘Top Ten List of Transfusion Medicine Randomized Control Trials in Transfusion Medicine’, ranking them in reverse order related to their impact and quality.…”