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Transfusion and Apheresis Science :... Aug 2020Over the last decade there has been a worldwide increase in the demand of platelet concentrates (PCs) for transfusion. This is, to a great extent, due to a growing and... (Review)
Review
Over the last decade there has been a worldwide increase in the demand of platelet concentrates (PCs) for transfusion. This is, to a great extent, due to a growing and aging population with the concomitant increase in the incidence of onco-hematological diseases, which require frequent platelet (PLT) transfusions. Currently, PLTs are sourced uniquely from donations, and their storage time is limited only to a few days. The necessity to store PCs at room temperature (to minimize loss of PLT functional integrity), poses a major risk for bacterial contamination. While the implementation of pathogen reduction treatments (PRTs) and new-generation PLT additive solutions have allowed the extension of the shelf life and a safer PLT transfusion product, the concern of PCs shortage still pressures the scientific community to find alternative solutions with the aim of meeting the PLT transfusion increasing demand. In this concise report, we will focus on the efforts made to produce, in in vitro culture, high yields of viable and functional PLTs for transfusion purposes in a cost-effective manner, meeting not only current Good Manufacturing Practices (cGMPs), but also transfusion safety standards.
Topics: Blood Platelets; Humans; Platelet Transfusion
PubMed: 32646795
DOI: 10.1016/j.transci.2020.102864 -
Transfusion Jun 2021Degree of thrombocytopenia is not a predictor of bleeding risk in neonates, yet most platelet transfusions are given prophylactically in non-bleeding premature infants.... (Review)
Review
Degree of thrombocytopenia is not a predictor of bleeding risk in neonates, yet most platelet transfusions are given prophylactically in non-bleeding premature infants. Recent data support a lower platelet transfusion threshold of 25 × 10 /L in non-bleeding premature neonates and indicate that higher transfusion thresholds may be associated with harm including increased risk of death and bleeding. The mechanism of increased adverse events with higher platelet transfusion threshold is unknown, but considerations include adult platelets disrupting the neonatal hemostatic balance of hypoactive platelets in a hypercoagulable and fragile environment and having a pro-inflammatory effect.
Topics: Blood Platelets; Hemorrhage; Humans; Infant; Infant, Newborn; Infant, Premature; Platelet Count; Platelet Transfusion; Thrombocytopenia
PubMed: 33786866
DOI: 10.1111/trf.16386 -
Transfusion and Apheresis Science :... Jun 2017The transfusion of platelet concentrates prepared from allogeneic single or pooled donations is a standard procedure in transfusion medicine to stop or prevent bleeding... (Review)
Review
The transfusion of platelet concentrates prepared from allogeneic single or pooled donations is a standard procedure in transfusion medicine to stop or prevent bleeding in cancer patients with thrombocytopenia undergoing surgery, chemotherapy and/or radiotherapy. While platelet transfusion may appear reasonable in many instances, greater scientific and medical attention should however be given to the possibly insidious impact of transfused platelets on the outcome of cancers. Indeed platelets and the microvesicles they release possess all the biological ingredients capable of supporting tumor growth, protecting circulating tumor cells, and to contributing to metastatic invasion. Until any randomized controlled trials can objectively document their effects on survival or cancer recurrence, minimizing the use of platelet transfusion in cancer patients appears to represent a reasonable precautionary measure.
Topics: Female; Humans; Male; Neoplasms; Platelet Transfusion; Thrombocytopenia
PubMed: 28606448
DOI: 10.1016/j.transci.2017.05.016 -
Hamostaseologie Apr 2021Aside from their canonical role in hemostasis, it is increasingly recognized that platelets have inflammatory functions and can regulate both adaptive and innate immune... (Review)
Review
Aside from their canonical role in hemostasis, it is increasingly recognized that platelets have inflammatory functions and can regulate both adaptive and innate immune responses. The main topic this review aims to cover is the proinflammatory effects and side effects of platelet transfusion. Platelets prepared for transfusion are subject to stress injury upon collection, preparation, and storage. With these types of stress, they undergo morphologic, metabolic, and functional modulations which are likely to induce platelet activation and the release of biological response modifiers (BRMs). As a consequence, platelet concentrates (PCs) accumulate BRMs during processing and storage, and these BRMs are ultimately transfused alongside platelets. It has been shown that BRMs present in PCs can induce immune responses and posttransfusion reactions in the transfusion recipient. Several recent reports within the transfusion literature have investigated the concept of platelets as immune cells. Nevertheless, current and future investigations will face the challenge of encompassing the immunological role of platelets in the scope of transfusion.
Topics: Humans; Platelet Count; Platelet Transfusion
PubMed: 33711849
DOI: 10.1055/a-1347-6551 -
Cancer Control : Journal of the Moffitt... Jan 2015Platelet transfusion is a critical and often necessary aspect of managing cancer. Low platelet counts frequently lead to bleeding complications; however, the drugs used... (Review)
Review
BACKGROUND
Platelet transfusion is a critical and often necessary aspect of managing cancer. Low platelet counts frequently lead to bleeding complications; however, the drugs used to combat malignancy commonly lead to decreased production and destruction of the very cell whose function is essential to stop bleeding. The transfusion of allogeneic platelet products helps to promote hemostasis, but alloimmunization may make it difficult to manage other complications associated with cancer.
METHODS
The literature relating to platelet transfusion in patients with cancer was reviewed.
RESULTS
Platelet storage, dosing, transfusion indications, and transfusion response are essential topics for health care professionals to understand because many patients with cancer will require platelet transfusions during the course of treatment. The workup and differentiation of non-immune-mediated compared with immune-mediated platelet refractoriness are vital because platelet management is different between types of refractoriness.
CONCLUSIONS
A combination of appropriate utilization of platelet inventory and laboratory testing coupled with communication between those caring for patients with cancer and those providing blood products is essential for effective patient care.
Topics: Blood Platelets; Hemorrhage; Humans; Neoplasms; Platelet Count; Platelet Transfusion; Thrombocytopenia
PubMed: 25504278
DOI: 10.1177/107327481502200107 -
Seminars in Thrombosis and Hemostasis Apr 2020Platelet transfusion is conventionally used to prevent or treat bleeding in patients with low platelet counts or impaired platelet function. The identification of... (Review)
Review
Platelet transfusion is conventionally used to prevent or treat bleeding in patients with low platelet counts or impaired platelet function. The identification of accurate thresholds of platelet count for guiding platelet transfusion practices is a crucial aspect in health care to prevent adverse events, side effects, unwarranted costs for the health care service, and deprivation of supplies. This article is therefore aimed at providing a narrative overview on current guidelines and recommendations for platelet transfusion across many clinical settings, including platelet function disorders, and critically analyzing the available platelet transfusion thresholds according to the current analytical performance of platelet counting with automated hematological analyzers. Overall, universal agreement on the definition of platelet transfusion thresholds has not been reached. The degree of accuracy and imprecision of many fully automated hematological analyzers appears also unsatisfactory, especially at the lower thrombocytopenic range, and this may thus jeopardize the managed care of patients who are candidates for platelet transfusions. Potential solutions to overcome the current shortcomings of automated platelet counting are also discussed, encompassing the use of alternative tests for guiding platelet transfusion (e.g., thrombin generation assays or thromboelastography) along with innovative approaches for platelet enumeration (e.g., fluorescent labeling and flow cytometry).
Topics: Hemorrhage; Humans; Platelet Count; Platelet Transfusion
PubMed: 31563129
DOI: 10.1055/s-0039-1696943 -
Shock (Augusta, Ga.) May 2017Thrombocytopenia is prevalent in critical care, surgical, and trauma settings. Despite the fact that a significant proportion of these patients receive platelet... (Review)
Review
Thrombocytopenia is prevalent in critical care, surgical, and trauma settings. Despite the fact that a significant proportion of these patients receive platelet transfusion during their hospital course, much work remains to be done with regard to development of platelet transfusion guidelines. Given the wide variety of platelet transfusion practices and the frequency with which patients present with thrombocytopenia, it is paramount to understand standards of care and to identify deficiencies that may exist. This review explores evidence and recommendations for platelet transfusion thresholds and practices in a variety of critical care and surgical settings with specific focus on the role of platelet transfusion in trauma, management and reversal of anticoagulation, and point of care laboratory assays. To this end, a literature review was performed utilizing PubMed and Cochrane Central Register of Controlled Trials to select 153 manuscripts that evaluate the current data supporting platelet transfusions in surgical and critical care populations. Advances in transfusion medicine and synthetic platelet substitutes that can be engineered for potential future applications will also be discussed.
Topics: Critical Care; Humans; Platelet Transfusion; Thrombocytopenia
PubMed: 27849676
DOI: 10.1097/SHK.0000000000000794 -
Clinics in Laboratory Medicine Dec 1996Although platelet transfusion is a vital part of modern hemotherapy, many related issues are unresolved. The most appropriate trigger point of transfusion and the... (Review)
Review
Although platelet transfusion is a vital part of modern hemotherapy, many related issues are unresolved. The most appropriate trigger point of transfusion and the clinical utility of prophylactic transfusion are still debated, but the importance of patient-specific transfusion decisions is clear. Leukocyte reduction and single donor platelets may have important roles in avoiding complications, but more data are needed. Establishment of a standardized protocol for managing patients receiving ongoing platelet transfusions may facilitate application of special techniques and the use of specially chosen units that provide better platelet support for thrombocytopenic patients.
Topics: Blood Component Removal; Blood Donors; Blood Grouping and Crossmatching; Humans; Platelet Transfusion; Thrombocytopenia
PubMed: 8974196
DOI: No ID Found -
Transfusion Medicine Reviews Apr 2017Platelet products have been increasingly used for more than 50 years. Platelet transfusion is effective for correcting bleeding caused by thrombocytopenia and platelet... (Review)
Review
Platelet products have been increasingly used for more than 50 years. Platelet transfusion is effective for correcting bleeding caused by thrombocytopenia and platelet function defects. In this review, we will outline research on platelet transfusion in China including platelet biosafety, cryopreservation of platelets, the assessment of the effectiveness of platelet transfusion, the causes of platelet transfusion refractoriness including immunization against CD36, and neonatal alloimmune thrombocytopenia.
Topics: Biomedical Research; Blood Preservation; Blood Safety; China; Humans; Platelet Transfusion; Transfusion Medicine
PubMed: 27914736
DOI: 10.1016/j.tmrv.2016.11.005 -
Transfusion Aug 2023Even in the era of the COVID-19 pandemic, trauma remains the global leading cause of mortality under the age of 49. Trauma-induced coagulopathy is a leading driver of...
BACKGROUND
Even in the era of the COVID-19 pandemic, trauma remains the global leading cause of mortality under the age of 49. Trauma-induced coagulopathy is a leading driver of early mortality in critically ill patients, and transfusion of platelet products is a life-saving intervention to restore hemostasis in the bleeding patient. However, despite extensive functional studies based on viscoelastic assays, limited information is available about the impact of platelet transfusion on the circulating molecular signatures in trauma patients receiving platelet transfusion.
MATERIALS AND METHODS
To bridge this gap, we leveraged metabolomics and proteomics approaches to characterize longitudinal plasma samples (n = 118; up to 11 time points; total samples: 759) from trauma patients enrolled in the Control Of Major Bleeding After Trauma (COMBAT) study. Samples were collected in the field, in the emergency department (ED), and at intervals up to 168 h (7 days) post-hospitalization. Transfusion of platelet (PLT) products was performed (n = 30; total samples: 250) in the ED through 24 h post-hospitalization. Longitudinal plasma samples were subjected to mass spectrometry-based metabolomics and proteomics workflows. Multivariate analyses were performed to determine omics markers of transfusion of one, two, three, or more PLT transfusions.
RESULTS
Higher levels of tranexamic acid (TXA), inflammatory proteins, carnitines, and polyamines were detected in patients requiring PLT transfusion. Correlation of PLT units with omics data suggested sicker patients required more units and partially overlap with the population requiring transfusion of packed red blood cell products. Furthermore, platelet activation was likely increased in the most severely injured patients. Fatty acid levels were significantly lower in PLT transfusion recipients (at time of maximal transfusion: Hour 4) compared with non-recipients, while carnitine levels were significantly higher. Fatty acid levels restore later in the time course (e.g., post-PLT transfusion).
DISCUSSION
The present study provides the first multi-omics characterization of platelet transfusion efficacy in a clinically relevant cohort of trauma patients. Physiological alterations following transfusion were detected, highlighting the efficacy of mass spectrometry-based omics techniques to improve personalized transfusion medicine. More specialized clinical research studies focused on PLT transfusion, including organized pre and post transfusion sample collection and limitation to PLT products only, are required to fully understand subsequent metabolomic and proteomic alterations.
Topics: Humans; Platelet Transfusion; Pandemics; Proteomics; COVID-19; Hemorrhage; Fatty Acids
PubMed: 37466356
DOI: 10.1111/trf.17472