Storage time of platelet concentrates and all‐cause bacteremia in hematologic patients

Abstract

BACKGROUND:Extension of storage time of platelet (PLT) concentrates may result in an increased risk of bacteremia, directly via transfusion of contaminated products or indirectly via transfusion-related immunomodulation. We aimed to quantify the association of storage time of PLT concentrates and all-cause bacteremia in hematologic patients. STUDY DESIGN AND METHODS:We established a cohort of hematologic patients who received a PLT transfusion between 2005 and 2015. Cases were defined as patients with a bacteremia the day after transfusion and matched to as many controls as possible. A conditional logistic regression was performed, stratified by storage medium. RESULTS:Among 3514 patients receiving 36,032 PLT concentrates stored in plasma, 613 cases of bacteremia were found. The relative risk of all-cause bacteremia the day after transfusion was 0.80 (95% confidence interval [CI], 0.58-1.12) for PLT concentrates stored 3 to 4 days and 0.67 (95% CI, 0.49-0.92) for at least 5 days, compared to no more than 2 days. Among 1527 patients receiving 11,822 PLT concentrates stored in PLT additive solution, 182 cases of bacteremia were found. The relative risk of all-cause bacteremia was 1.14 (95% CI, 0.70-1.84) for PLT concentrates stored for 3 to 4 days and 1.19 (95% CI, 0.70-2.01) for at least 5 days, compared to not more than 2 days.CONCLUSION: Storage time of PLT concentrates was not associated with increased occurrence of all-cause bacteremia the day after transfusion. If anything, fewer cases of bacteremia occurred with increasing storage time of PLT concentrates in plasma. These bacteremias are not directly caused by transfusion of a contaminated product and the underlying mechanism warrants further research. (PLTs) is an important aspect of supportive care in the treatment of patients with hematologic malignancies, to prevent or treat bleeding complications during periods of severe thrombocytopenia. T ransfusion of platelets1,2 The concurrent neutropenia predisposes these patients to infectious complications. 3Transfusions can directly cause bacterial infections via transmission of bacteria through contaminated products. In particular PLT concentrates may carry this risk, as these are stored at room temperature, allowing bacterial proliferation. This is clearly illustrated by several case reports of severe bacterial sepsis after transfusion of contaminated PLT concentrates. [4][5][6][7] In an attempt to reduce this risk, storage time is limited to 3.5 days in Japan and to 4 or 5 days in the United States and Germany. trial in the United States, which aimed to investigate the safety of 7 days' storage with the implementation of early testing, was terminated early due to concerns about the residual risk of transfusion of contaminated PLT concentrates.12 However, storage up to 7 days in combination with bacterial screening is allowed in, among other countries, Spain, the United Kingdom, Sweden, and the Netherlands. 11 Bacterial screening does not eliminate the risk of septic reactions completely as false-negative re...

Storage time of platelet concentrates and risk of a positive blood culture: a nationwide cohort study

“…These findings are consistent with the results of our previous study. In a population of Dutch hematologic patients, the risk of bacteremia was lower the day after transfusion of PLT concentrates stored in plasma for 5 to 7 days compared to those stored 1 or 2 days . In the Dutch study, we only included days on which a patient received PLT concentrates exclusively of a single storage time category.…”

“…The association was limited to transfusion of PLT concentrates stored in plasma, whereas storage time was not associated with the risk of all‐cause bacteremia when the PLTs were stored in PLT additive solution (PAS). However, the power of the latter analysis was limited by the sample size for PLTs stored in PAS‐C and the maximal storage time of 5 days for PLTs in PAS‐B …”

“…However, the power of the latter analysis was limited by the sample size for PLTs stored in PAS-C and the maximal storage time of 5 days for PLTs in PAS-B. 13 In Denmark, all PLT concentrates are stored in PAS-C with a maximal storage time of 7 days. This study aimed at investigating the effect of storage for 6 or 7 days on risk of a positive blood culture at different times after transfusion in all recipients of a PLT transfusion by using administrative health care data.…”

Effect of storage of platelet concentrates in PAS‐B, PAS‐C, or plasma on transfusion reactions

“…Anonymized data, further described below, were obtained from the national hemovigilance organization Transfusion and Transplantation Reactions in Patients (TRIP) and the national Sanquin database (eProgesa, MAKsystems). The reference distribution of the storage time of all transfused platelet units was estimated using a database, as described earlier, containing data of more than 100,000 pooled platelet units transfused in the Netherlands …”

“…The reaction type “allergic reaction” included both anaphylactic reactions and other allergic reactions. (Suspected) bacterial and viral transfusion transmitted infections were excluded, as these have been reported elsewhere . The reaction type “other reaction” is a collection of reactions that do not fit in the definition of one of the reaction categories defined by TRIP.…”