I am the 9%: Making the case for whole‐blood platelets

Abstract

Over the last 15 years, there has been a trend in the United States towards the increasing use of apheresis platelet (AP) concentrates over whole-blood-derived platelets (WBP). Although 1-h- and 24-h-corrected count increments tend to be higher with AP, this does not translate into improved haemostatic efficiency when used to prevent bleeding in haematology/oncology patients. WBP expose the recipient to more donors than apheresis products. However, recent studies have shown no significant differences in the rates of bacterial contamination, human leukocyte antigen alloimmunisation, RhD alloimmunisation, transfusion-related acute lung injury or febrile non-haemolytic transfusion reactions between these two products. Given the overall low rates of virally contaminated units in the era of nucleic acid testing and rigorous donor screening, the difference in donor exposures of 4-6 vs 1 has minimal clinical relevance. Although studies point to a marginally increased risk of donor adverse events associated with WBP, the absolute risk is too miniscule to act as a deterrent to making whole-blood donations. Both types of platelet concentrates should therefore be considered clinically equivalent; in this light, the most responsible use of the community donor resource pool, which both optimises the utility of a whole-blood donation and meets the clinical needs of thrombocytopenic recipients, is to have a mix of both types of platelet products so as to mitigate the risk of shortages.

Platelet Transfusion Induces Alloimmunization to D and Non-D Rhesus Antigens

“…Since the introduction of mandatory universal pathogen inactivation of all PC in 2011 [2], AP-PC and BC-PC are considered clinically equivalent. However, some differences exist between both types of PC, such as the extent of residual contaminating red blood cells (RBC), which has been shown to be considerably lower for AP-PC (0.00017-0.009 ml) compared to BC-PC (0.036-0.59 ml) [3,4,5,6,7,8]. …”

Predisposing factors for anti‐D immune response in D− patients with chronic liver disease transfused with D+ platelet concentrates

“…No anti‐D alloimmunization was reported in three studies using only apheresis PCs . RBC levels are generally two orders of magnitude higher in PCs prepared from whole blood than in apheresis PCs . They may therefore exceed the threshold required to induce anti‐D antibody production, although recent reports suggest that microparticles present in apheresis PCs may also induce RBC alloimmunization …”

“…[26][27][28] RBC levels are generally two orders of magnitude higher in PCs prepared from whole blood than in apheresis PCs. 3,29 They may therefore exceed the threshold required to induce anti-D antibody production, although recent reports suggest that microparticles present in apheresis PCs may also induce RBC alloimmunization. 30 Third, disease status probably plays a role in the higher rate of alloimmunization observed in this study than in recent studies of hematology and oncology patients.…”

Whole blood–derived platelets: keeping our platelet inventory whole

“…Nabiha Huq Saifee , 1,2 Rebecca Haley, 2 and Theresa Nester 1,2 Whole blood-derived platelet (WBDP) distribution has declined dramatically in the United States from 32.3% in 2001 to only 7.6% in 2013. 1 This national trend is not reflected in the greater Seattle area where WBDPs still account for approximately 30% of platelet (PLT) distribution.…”

“…Data have also shown that leukoreduced WBDPs have similar hemostatic efficacy and HLA alloimmunization rate compared to leukoreduced APs and that both products carry a low risk of transfusion-related adverse events in the era of viral nucleic acid testing and bacterial testing. 2 With increased regulations and national trends of decreased donations and increased PLT usage, maintenance of an adequate PLT supply is becoming more challenging. WBDPs maximize the whole blood donor's gift and may help mitigate PLT shortages.…”