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TheScientificWorldJournal Mar 2011Despite bacterial culture of platelets, transfusion-associated bacteremia/sepsis (TABS) may occur with a frequency of approximately 1/60,000 platelet transfusions, while... (Review)
Review
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.
Topics: Humans; Platelet Transfusion; Risk Reduction Behavior; United States
PubMed: 21403979
DOI: 10.1100/tsw.2011.60 -
Platelets Jan 2018The transfusion of platelets is essential for diverse pathological conditions associated with thrombocytopenia or platelet disorders. To maintain optimal platelet... (Review)
Review
The transfusion of platelets is essential for diverse pathological conditions associated with thrombocytopenia or platelet disorders. To maintain optimal platelet quality and functions, platelets are stored as platelet concentrates (PCs) at room temperature under continuous agitation-conditions that are permissive for microbial proliferation. In order to reduce these contaminants, pathogen reduction technologies (PRTs) were developed by the pharmaceutical industry and subsequently implemented by blood banks. PRTs rely on chemically induced cross-linking and inactivation of nucleic acids. These technologies were initially introduced for the treatment of plasma and, more recently, for PCs given the absence of a nucleus in platelets. Several studies verified the effectiveness of PRTs to inactivate a broad array of bacteria, viruses, and parasites. However, the safety of PRT-treated platelets has been questioned in other studies, which focused on the impact of PRTs on platelet quality and functions. In this article, we review the literature regarding PRTs, and present the advantages and disadvantages related to their application in platelet transfusion medicine.
Topics: Blood Platelets; Blood Preservation; Cell-Derived Microparticles; Cytokines; Humans; Infection Control; Leukocyte Count; Mitochondria; Platelet Function Tests; Platelet Transfusion; Proteome
PubMed: 28523956
DOI: 10.1080/09537104.2017.1306046 -
Vox Sanguinis Jul 2020Platelet has been linked to thrombosis in several studies. Inflammation is closely intertwined with thrombosis and occurs consecutively; it is therefore conceivable that...
BACKGROUND AND OBJECTIVES
Platelet has been linked to thrombosis in several studies. Inflammation is closely intertwined with thrombosis and occurs consecutively; it is therefore conceivable that platelet transfusions perform an increasingly vital role in inflammation. As platelet transfusions have been a significant therapeutic approach in patients for decades, serious risks including viral transmission, bacterial sepsis and acute lung injury have been demonstrated by retrospective studies and randomized clinical trials. Recent data suggest associations among platelet transfusion and pro-inflammatory responses.
MATERIALS AND METHODS
A systematic review (from 2014 to 2019) on English literatures was conducted. Data on platelet transfusion-related reactions were abstracted. Preset inclusion and exclusion criteria were applied to identify all eligible articles.
RESULTS
All patients abstracted have received platelet transfusion. This new review focuses on recent 5-year advances (from 2014 to 2019) to have found that the platelet transfusion as pro-inflammatory process, concerning secretion of platelet microparticles and other inflammatory factors.
CONCLUSION
It can be hypothesized that the platelet microparticles or biological response modifier pathways might be innovative and therapeutic approaches to improving platelet transfusion and pretransfusion manipulations to reduce transfusion-related adverse reactions and therefore improve the efficacy and safety of this wide-employed therapy.
Topics: Humans; Inflammation; Platelet Transfusion; Retrospective Studies
PubMed: 32293034
DOI: 10.1111/vox.12879 -
Journal of Cardiothoracic and Vascular... Jul 2024
Topics: Humans; Cardiac Surgical Procedures; Platelet Transfusion
PubMed: 38553350
DOI: 10.1053/j.jvca.2024.02.033 -
The Journal of Maternal-fetal &... Oct 2011Even though for certain varieties of neonatal thrombocytopenia, intravenous immunoglobulin or corticosteroids are recommended as treatments, platelet transfusions... (Review)
Review
Even though for certain varieties of neonatal thrombocytopenia, intravenous immunoglobulin or corticosteroids are recommended as treatments, platelet transfusions represent the only specific therapy currently available for most thrombocytopenic neonates in NICUs. The majority of these NICU platelet transfusions, up to 98% in some recent reports, are given to prevent, rather than to treat, bleeding. The trigger limit of platelet count to prophylactically treat non-bleeding patients is generally arbitrary. A complete definition, of the benefits and the risks of prophylactic platelet transfusions in thrombocytopenic neonates is necessary. In fact, there is great variability worldwide in neonatal platelet transfusion practice, due to the lack of concrete evidence to guide transfusion decisions. Evidence-based guidelines do not exist to decide when platelet transfusion should be given. The practice of neonatal platelet transfusions is based almost entirely on expert opinion and reasoning. Consequently, these practices, not supported by definitive data, vary widely. To increase benefits and safety, new widespread changes in platelet transfusion guidelines are necessary. New transfusion paradigms should not be based on reasoning alone, but on important experimental validation. The neonatologists would better accept them and more closely adhere to.
Topics: Evidence-Based Practice; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Platelet Transfusion; Practice Guidelines as Topic; Preventive Medicine; Risk Assessment
PubMed: 21878062
DOI: 10.3109/14767058.2011.607577 -
The National Medical Journal of India 2023
Topics: Humans; Platelet Transfusion; Catheterization, Central Venous
PubMed: 38759985
DOI: 10.25259/NMJI_568_2023 -
Anesthesia and Analgesia Aug 2022Incorporation of massive transfusion protocols (MTPs) into acute major trauma care has reduced hemorrhagic mortality, but the threshold and timing of platelet...
BACKGROUND
Incorporation of massive transfusion protocols (MTPs) into acute major trauma care has reduced hemorrhagic mortality, but the threshold and timing of platelet transfusion in MTP are controversial. This study aimed to describe early (first 4 hours) platelet transfusion practice in a setting where platelet counts are available within 15 minutes and the effect of early platelet deployment on in-hospital mortality. Our hypothesis in this work was that platelet transfusion in resuscitation of severe trauma can be guided by rapid turnaround platelet counts without excess mortality.
METHODS
We examined MTP activations for all admissions from October 2016 to September 2018 to a Level 1 regional trauma center with a full trauma team activation. We characterized platelet transfusion practice by demographics, injury severity, and admission vital signs (as shock index: heart rate/systolic blood pressure) and laboratory results. A multivariable model assessed association between early platelet transfusion and mortality at 4 hours, 24 hours, and overall in-hospital, with P <.001.
RESULTS
Of the 11,474 new trauma patients admitted over the study period, 469 (4.0%) were massively transfused (defined as ≥10 units of red blood cells [RBCs] in 24 hours, ≥5 units of RBC in 6 hour, ≥3 units of RBC in 1 hour, or ≥4 units of total products in 30 minutes). 250 patients (53.0%) received platelets in the first 4 hours, and most early platelet transfusions occurred in the first hour after admission (175, 70.0%). Platelet recipients had higher injury severity scores (mean ± standard deviation [SD], 35 ± 16 vs 28 ± 14), lower admission platelet counts (189 ± 80 × 10 9 /L vs 234 ± 80 × 10 9 /L; P < .001), higher admission shock index (heart rate/systolic blood pressure; 1.15 ± 0.46 vs 0.98 ± 0.36; P < .001), and received more units of red cells in the first 4 hours (8.7 ± 7.7 vs 3.3 ± 1.6 units), 24 hours (9 ± 9 vs 3 ± 2 units), and in-hospital (9 ± 8 vs 3 ± 2 units) than nonrecipients (all P < .001). We saw no difference in 4-hour (8% vs 7.8%; P = .4), 24-hour (16.4% vs 10.5%; P = .06), or in-hospital mortality (30.4% vs 23.7%; P = .1) between platelet recipients and nonrecipients. After adjustment for age, injury severity, head injury, and admission physiology/laboratory results, early platelet transfusion was not associated with 4-hour, 24-hour, or in-hospital mortality.
CONCLUSIONS
In an advanced trauma care setting where platelet counts are available within 15 minutes, approximately half of massively transfused patients received early platelet transfusion. Early platelet transfusion guided by protocol-based clinical judgment and rapid-turnaround platelet counts was not associated with increased mortality.
Topics: Blood Transfusion; Humans; Platelet Transfusion; Resuscitation; Retrospective Studies; Trauma Centers; Wounds and Injuries
PubMed: 35522847
DOI: 10.1213/ANE.0000000000005982 -
Vox Sanguinis Jul 2004
Review
Topics: Bleeding Time; Blood Component Removal; Blood Platelets; Blood Transfusion; Clinical Trials as Topic; Humans; Plasma; Platelet Transfusion; Specimen Handling; Thrombocytopenia; Time Factors
PubMed: 15209878
DOI: 10.1111/j.1741-6892.2004.00499.x -
Current Opinion in Hematology Nov 2002This review discusses the causes of refractoriness to platelet transfusions and presents three options for its management. Platelet refractoriness is a complication of... (Review)
Review
This review discusses the causes of refractoriness to platelet transfusions and presents three options for its management. Platelet refractoriness is a complication of platelet transfusion that affects variable proportions of patients, mostly depending on their diagnosis, previous immunologic stimuli, and type of blood products used for transfusion. A large recent study showed that platelet refractoriness develops in 13% of patients with acute leukemia transfused with traditional blood products and in 3 to 4% of recipients of white cell-reduced blood components. Options to manage platelet refractoriness include platelets from HLA-typed donors, platelet cross-matching, and the antibody specificity prediction method. The selection of the most convenient approach depends on local skills and the available economic and organizational resources. Finally, emerging concepts are presented which could impact the management of platelet refractoriness.
Topics: Histocompatibility Testing; Humans; Leukemia; Platelet Transfusion; Treatment Failure
PubMed: 12394175
DOI: 10.1097/00062752-200211000-00009 -
Transfusion Feb 2020Platelet transfusion is aimed at increasing platelet counts to prevent or treat bleeding. Critically ill cancer patients with hypoproliferative thrombocytopenia are high...
BACKGROUND
Platelet transfusion is aimed at increasing platelet counts to prevent or treat bleeding. Critically ill cancer patients with hypoproliferative thrombocytopenia are high consumers of blood products. We herein described their post-transfusion platelet responses in the intensive care unit (ICU) and analyzed the determinants of poor post-transfusion increments.
STUDY DESIGN AND METHODS
This was a single-center 9-year (2009-2017) retrospective observational study. Patients with malignancies and presumed or proven hypoproliferative thrombocytopenia who had received at least one platelet transfusion in the ICU were included. Poor post-transfusion platelet increments were defined as body surface-adjusted corrected count increment (CCI) <7, or alternatively as weight-adjusted platelet transfusion recovery (PTR) <0.2. Patients were deemed refractory to platelet transfusions when two consecutive ABO-compatible transfusions resulted in poor platelet increments.
RESULTS
A total of 1470 platelet transfusions received by 326 patients were analyzed. Indications for platelet transfusions were distributed into prophylactic (44.5%), peri-procedural (18.1%) and therapeutic (37.4%). Regardless of indications, 54.6% and 55.4% of transfusion episodes were associated with a CCI <7 or a PTR <0.2. Factors independently associated with poor post-transfusion increments were lower body mass index, spleen enlargement, concurrent severity of clinical condition, fever ≥39°C, antibiotic therapy and increased storage duration of platelet concentrates. Eventually, 48 patients developed refractoriness to platelet transfusion, which was associated increased incidence of bleeding events.
CONCLUSION
Platelet transfusions are often associated with poor increments in critically ill cancer patients with hypoproliferative thrombocytopenia. The findings suggest amenable interventions to improve the platelet transfusion practices in this setting.
Topics: Aged; Critical Illness; Female; Humans; Intensive Care Units; Male; Middle Aged; Platelet Transfusion; Retrospective Studies; Thrombocytopenia
PubMed: 31724828
DOI: 10.1111/trf.15596