Platelet transfusion increases risk for acute respiratory distress syndrome in non-massively transfused blunt trauma patients

Kasotakis, George; Starr, Nichole; Nelson, Erek; Sarkar, Bedabrata; Burke, Peter; Remick, Daniel G.; Tompkins, Ronald G.; Investigators, Host Response to Injury

doi:10.1007/s00068-018-0953-4

Cited by 20 publications

(12 citation statements)

References 42 publications

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“…Kasotakis and coworkers investigated the effect of platelet transfusions in multiple trauma patients. According to their results, high-volume platelet transfusions are associated with the development of ARDS [ 52 ]. This supports the theory of a detrimental effect of platelets on lung physiology.…”

Section: Discussionmentioning

confidence: 99%

Correlation between Platelet Count and Lung Dysfunction in Multiple Trauma Patients—A Retrospective Cohort Analysis

Greve

Mair

Aulbach

et al. 2022

JCM

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(1) Background: Current findings emphasize the potential contribution of platelets to the immunological response after severe trauma. As clinical relevance remains unclear, this study aims to analyze the correlation between platelets and lung dysfunction in severely injured patients. (2) Methods: We retrospectively enrolled all multiple trauma patients presenting to our level 1 trauma center from 2015 to 2016 with an Injury-Severity Score (ISS) ≥ 16. Apart from demographic data, platelet counts and PaO2/FiO2 as an approximate indicator for lung physiology were analyzed and correlated on subsequent days after admission. (3) Results: 83 patients with a median ISS of 22 (IQR 18–36) were included. Compared to day 1, platelet counts were decreased on day 3 (p = ≤ 0.001). Platelet counts were significantly lower on day 3 in patients with an ISS ≥ 35 (p = 0.011). There were no differences regarding PaO2/FiO2 index. Correlation analysis revealed a positive link between increased platelet counts and PaO2/FiO2 index on day 1 only in severely injured patients (p = 0.007). (4) Conclusions: This work supports the concept of platelets modulating the posttraumatic immune response by affecting lung dysfunction in the early phase after multiple trauma in dependence of injury severity. Our findings contribute to the understanding of the impact of platelets on systemic processes in multiple trauma patients.

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Section: Discussionmentioning

confidence: 99%

Correlation between Platelet Count and Lung Dysfunction in Multiple Trauma Patients—A Retrospective Cohort Analysis

Greve

Mair

Aulbach

et al. 2022

JCM

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“…On the opposite, Sambasivan and colleagues reported that high ratios of platelet unit:RBC (> 1:2) administrated to non-massively transfused trauma patients had no effect on mortality compared to low ratios (≤ 1:2) but significantly decreased ventilator-free and ICU-free days [ 20 ]. In another study also including non-massively transfused blunt injury victims, platelet transfusion was found to increase the risk of acute respiratory distress syndrome without any survival benefit, but platelet transfusion was recorded over 48 h and only 488 patients were included [ 21 ]. Our study provided the opportunity to examine a large cohort of trauma patients and suggested that early platelet transfusion improved survival, not only in massively transfused patients but also in severely bleeding trauma patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of platelet transfusion on outcomes in trauma patients

et al. 2022

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Background Trauma-induced coagulopathy includes thrombocytopenia and platelet dysfunction that impact patient outcome. Nevertheless, the role of platelet transfusion remains poorly defined. The aim of the study was 1/ to evaluate the impact of early platelet transfusion on 24-h all-cause mortality and 2/ to describe platelet count at admission (PCA) and its relationship with trauma severity and outcome. Methods Observational study carried out on a multicentre prospective trauma registry. All adult trauma patients directly admitted in participating trauma centres between May 2011 and June 2019 were included. Severe haemorrhage was defined as ≥ 4 red blood cell units within 6 h and/or death from exsanguination. The impact of PCA and early platelet transfusion (i.e. within the first 6 h) on 24-h all-cause mortality was assessed using uni- and multivariate logistic regression. Results Among the 19,596 included patients, PCA (229 G/L [189,271]) was associated with coagulopathy, traumatic burden, shock and bleeding severity. In a logistic regression model, 24-h all-cause mortality increased by 37% for every 50 G/L decrease in platelet count (OR 0.63 95% CI 0.57–0.70; p < 0.001). Regarding patients with severe hemorrhage, platelets were transfused early for 36% of patients. Early platelet transfusion was associated with a decrease in 24-h all-cause mortality (versus no or late platelets): OR 0.52 (95% CI 0.34–0.79; p < 0.05). Conclusions PCA, although mainly in normal range, was associated with trauma severity and coagulopathy and was predictive of bleeding intensity and outcome. Early platelet transfusion within 6 h was associated with a decrease in mortality in patients with severe hemorrhage. Future studies are needed to determine which doses of platelet transfusion will improve outcomes after major trauma.

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“…An association has been described between prophylactic PTs in invasive procedures and an increased risk for thrombosis and mortality, between prophylactic PTs in patients with intracranial hemorrhage and a greater mortality and worsening of the neurological condition, between PTs and an increased risk for respiratory distress in patients with major trauma, and between PTs and an increased risk for mortality and complications in patients undergoing myocardial revascularization surgery. [143][144][145][146] However, other studies in adults reported that a prophylactic PT is not associated with a greater risk. [147][148][149] A recent systematic review failed to draw conclusive conclusions in this regard.…”

Section: Megaplatelet Inclusion Bodymentioning

confidence: 99%

Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion

2021

Arch Argent Pediat

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Non-immune thrombocytopenia is caused by multiple pathologies; the most common causes are extra-or intrauterine infections, whereas secondary cases result from other pathologies involved in the fetal-placentalmaternal interface. This second article lists its causes and provides details of the different pathologies. Platelet transfusion is widely used in neonatology, both as treatment and as bleeding prophylaxis. However, there is no general consensus about the platelet count threshold that is convenient to indicate a transfusion or actual indications. Recent articles are commented regarding the different proposed strategies. The emphasis is on discussing the multiple adverse effects of platelet transfusions because knowledge about them is changing the paradigm for indications, suggesting that a much more restrictive policy is required.

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Platelet transfusion increases risk for acute respiratory distress syndrome in non-massively transfused blunt trauma patients

Abstract: Pre-emptive platelet transfusion should be avoided in non-massively transfused blunt injury victims in the absence of true or functional thrombocytopenia, as it increases risk for ARDS with no survival benefit.

Cited by 20 publications

References 42 publications

Correlation between Platelet Count and Lung Dysfunction in Multiple Trauma Patients—A Retrospective Cohort Analysis

Correlation between Platelet Count and Lung Dysfunction in Multiple Trauma Patients—A Retrospective Cohort Analysis

Impact of platelet transfusion on outcomes in trauma patients

Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion

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