Risk-Reduction Strategies for Platelet Transfusion in the United States

Abstract

Despite bacterial culture of platelets, transfusion-associated bacteremia/sepsis (TABS) may occur with a frequency of approximately 1/60,000 platelet transfusions, while an emerging transfusion-transmitted infection (TTI) could reproduce the epidemic of transfusion-transmitted human immunodeficiency virus (HIV) in the future. As platelet pathogen-reduction (PR) systems licensed in Europe may eventually become licensed in the U.S., three alternative strategies for reducing the residual risks of TTIs and TABS may become available in the U.S. in the future: (1) transfusion of (already-available) non–pathogen-reduced single-donor (as opposed to pooled whole-blood-derived [PWBD]) platelets, (2) transfusion of pathogen-reduced single-donor platelets, or (3) transfusion of pathogen-reduced PWBD platelets (if trials of this component are conducted in the U.S. in the future). PR of platelets will increase the risk of mild and moderate (albeit perhaps not severe) bleeding complications and it cannot protect from all pathogens. Compared to PWBD platelets, single-donor platelets can reduce, by at least twofold, the risk of all known and emerging TTIs, as well as the risk of TABS, without incurring any risk. The fewer donor exposures secured by the use of single-donor platelets – especially if combined with collection of red blood cells and/or plasma from the same donation for transfusion to the same recipient through the use of multicomponent apheresis – may also reduce the risk of transfusion-related acute lung injury. To choose between pathogen-reduced and non–pathogen-reduced single-donor platelets, the increased risks of bleeding complications as well as other possible adverse events secondary to PR need to be quantified precisely and weighed against the competing risks of TABS and emerging TTIs.

Observational study of corrected count increments after transfusion of platelets treated with riboflavin pathogen reduction technology in additive solutions

“…Blood donation screening, as formally recommended by the World Health Organization, can be a costly and time consuming burden, particularly in lower‐income countries. Many challenges exist to effectively screen for infectious pathogens, including developing assays that are sensitive enough to detect early infections when pathogen numbers and antibody levels may be very low …”

“…Many challenges exist to effectively screen for infectious pathogens, including developing assays that are sensitive enough to detect early infections when pathogen numbers and antibody levels may be very low. 4,5 The Mirasol pathogen reduction technology (PRT) system (Terumo BCT, Lakewood, CO) uses riboflavin and ultraviolet (UV) light for the inactivation of pathogens in blood components. The addition of riboflavin and exposure to 285-to 365-nm UV light leads to riboflavinmediated damage to nucleic acids.…”

A patient‐centric approach to preventing allergic reactions to platelet transfusions

“…2 Patients who continue to have ATRs after receiving concentrated APs and/or APs stored in PAS-III will have to be managed thereafter with washed APs, and it is important that the patient-centric aspects of their management recommended by Tobian and coworkers 2 (daily monitoring of PLT counts to increase PLT transfusions if necessary) be maintained in settings where a component-centric approach is used. A completely patient-centric approach to PLT transfusion would combine: 1) transfusing APs (rather than pooled whole blood-derived PLTs) to reduce the risk of transfusion-transmitted infections (TTIs) and PLT transfusion-associated sepsis by at least twofold; 15 2) reserving the PLTs and plasma and/or RBCs from the same multicomponent apheresis collection for transfusion to the same recipient to reduce the risk of TRALI 16,17 in addition to TTIs; and 3) concentrating (or washing if necessary) APs-or, alternatively, using APs stored in PAS-III-for patients prone to ATRs. 2 The greater frequency of ATRs in association with PLT and plasma (rather than RBC) transfusions is the basis for the prevailing belief that implicates a mediator(s) present in donor plasma in the pathogenesis of ATRs.…”

<p>Platelet Transfusion: And Update on Challenges and Outcomes</p>

“…14,18 In fact, the RDP units are associated with a 5-6 fold higher risk of bacterial contamination and a twofold higher risk of transfusion transmitted infection (TTI) compared to SDAP. 19,20 The current risk of TTI is very low in our area, having been confirmed in the last 15 years a reduction in the donor incidence rate and in the residual risk for the case of HBV. 21 However, emerging TTI could cause an epidemic situation similar to HIV virus infection and therefore use of RDP represents a higher infectious potential risk.…”