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Hamostaseologie Nov 2020The characterization of platelet concentrates (PCs) in transfusion medicine has been performed with different analytical methods and platelet lesions (from biochemistry... (Review)
Review
The characterization of platelet concentrates (PCs) in transfusion medicine has been performed with different analytical methods and platelet lesions (from biochemistry to cell biology) have been documented. In routine quality assessment and validation of manufacturing processes of PCs for transfusion purposes, only basic parameters are monitored and the platelet functions are not included. However, PCs undergo several manipulations during the processing and the basic parameters do not provide sensitive analyses to properly picture out the impact of the blood component preparation and storage on platelets. To improve the transfusion supply chain and the platelet functionalities, additional parameters should be used. The present short review will focus on the different techniques to monitor ex vivo platelet lesions from phenotype characterization to advanced omic analyses. Then, the opportunities to use these methods in quality control, process validation, development, and research will be discussed. Functional markers should be considered because they would be an advantage for the future developments in transfusion medicine.
Topics: Blood Platelets; Humans; Platelet Function Tests; Platelet Transfusion
PubMed: 32932547
DOI: 10.1055/a-1210-3229 -
Transfusion Oct 2022
Topics: Humans; Platelet Count; Platelet Transfusion; Standing Orders; Thrombocytopenia
PubMed: 36054127
DOI: 10.1111/trf.17066 -
Cleveland Clinic Journal of Medicine 1996Platelet transfusions have become more common as more patients undergo bone marrow transplantation and aggressive chemotherapy for malignant diseases. This paper reviews... (Review)
Review
Platelet transfusions have become more common as more patients undergo bone marrow transplantation and aggressive chemotherapy for malignant diseases. This paper reviews the indications for platelet transfusions and the factors that can decrease their effectiveness.
Topics: Contraindications; Humans; Patient Selection; Platelet Count; Platelet Transfusion; Risk Factors; Thrombocytopenia
PubMed: 8764695
DOI: 10.3949/ccjm.63.4.245 -
Journal of Clinical Oncology : Official... Jan 2018Purpose To provide evidence-based guidance on the use of platelet transfusion in people with cancer. This guideline updates and replaces the previous ASCO platelet...
Purpose To provide evidence-based guidance on the use of platelet transfusion in people with cancer. This guideline updates and replaces the previous ASCO platelet transfusion guideline published initially in 2001. Methods ASCO convened an Expert Panel and conducted a systematic review of the medical literature published from September 1, 2014, through October 26, 2016. This review builds on two 2015 systematic reviews that were conducted by the AABB and the International Collaboration for Transfusion Medicine Guidelines. For clinical questions that were not addressed by the AABB and the International Collaboration for Transfusion Medicine Guidelines (the use of leukoreduction and platelet transfusion in solid tumors or chronic, stable severe thrombocytopenia) or that were addressed partially (invasive procedures), the ASCO search extended back to January 2000. Results The updated ASCO review included 24 more recent publications: three clinical practice guidelines, eight systematic reviews, and 13 observational studies. Recommendations The most substantial change to a previous recommendation involved platelet transfusion in the setting of hematopoietic stem-cell transplantation. Based on data from randomized controlled trials, adult patients who undergo autologous stem-cell transplantation at experienced centers may receive a platelet transfusion at the first sign of bleeding, rather than prophylactically. Prophylactic platelet transfusion at defined platelet count thresholds is still recommended for pediatric patients undergoing autologous stem-cell transplantation and for adult and pediatric patients undergoing allogeneic stem-cell transplantation. Other recommendations address platelet transfusion in patients with hematologic malignancies or solid tumors or in those who undergo invasive procedures. Guidance is also provided regarding the production of platelet products, prevention of Rh alloimmunization, and management of refractoriness to platelet transfusion ( www.asco.org/supportive-care-guidelines and www.asco.org/guidelineswiki ).
Topics: Consensus; Humans; Medical Oncology; Neoplasms; Platelet Transfusion; Risk Factors; Stem Cell Transplantation; Treatment Outcome
PubMed: 29182495
DOI: 10.1200/JCO.2017.76.1734 -
Transfusion Medicine Reviews Jul 2011In 1955, animal studies suggested that thrombocytopenia was not the initiating cause of hemorrhage. Coagulation studies in vitro revealed the correction of coagulation... (Review)
Review
In 1955, animal studies suggested that thrombocytopenia was not the initiating cause of hemorrhage. Coagulation studies in vitro revealed the correction of coagulation by fresh platelets. Platelets, freshly collected with use of nonwettable surfaces, corrected thrombocytopenia, controlled associated hemorrhage, and prevented death from bleeding. Thus, in vitro and animal studies can be misleading (bench to bedside). Careful clinical observations, elaborated by in vitro studies, which create hypotheses testable in the clinic, lead to therapeutic advances (bedside to bench and back). Platelet replacement for thrombocytopenia prevents the hemorrhagic diathesis and has been universally practiced for over 50 years.
Topics: Animals; Blood Coagulation; Blood Platelets; History, 20th Century; History, 21st Century; Humans; Platelet Transfusion; Thrombocytopenia
PubMed: 21371858
DOI: 10.1016/j.tmrv.2011.01.003 -
Transfusion May 2018Transfusion of platelets is common in cardiac surgery, and while there are guidelines for their use, there are concerns about potential risks. We aimed to assess the...
BACKGROUND
Transfusion of platelets is common in cardiac surgery, and while there are guidelines for their use, there are concerns about potential risks. We aimed to assess the impact of platelet transfusion on mortality, thrombosis, and infection in this patient group.
STUDY DESIGN AND METHODS
A retrospective cohort study of all patients at St Vincent's Hospital Melbourne who underwent a first cardiac surgery procedure from June 2001 to June 2014 was conducted. A propensity-weighted analysis was performed to examine the association between intraoperative platelet transfusion and outcomes.
RESULTS
A total of 5233 patients met inclusion criteria, and 531 (10.15%) received intraoperative platelet transfusion (median two platelet doses, interquartile range, 1-17). Patients receiving platelets were older, had higher body mass index, lower rates of diabetes and dyslipidemia, higher rates of infective endocarditis, recent myocardial infarction and unstable angina, and exposure to aspirin or clopidogrel. On univariable analysis, platelet transfusion was associated with increased 30-day mortality (2.4% vs. 10.55%, p < 0.001), return to theatre for bleeding (3.23% vs. 13.37%, p < 0.001), and rates of any infection (9.26% vs. 19.17%, p < 0.001). After adjusting for confounders, platelet transfusion was not associated with increased risk of 30-day mortality or infective complications. Platelet transfusion was associated with higher rates of return to theatre (relative risk [RR], 2.46; confidence interval [CI], 1.42, 4.04; p = 0.001) and decreased risk of thromboembolic events (RR, 0.28; CI, 0.15, 0.51; p < 0.001).
CONCLUSION
Platelet transfusion was not associated with increased mortality or infective complications following first cardiac surgery. Further prospective studies are required to identify patients most likely to benefit from platelet transfusion.
Topics: Aged; Cardiac Surgical Procedures; Female; Hemorrhage; Humans; Infections; Male; Middle Aged; Platelet Transfusion; Retrospective Studies; Risk Assessment; Risk Factors; Thrombosis
PubMed: 29516497
DOI: 10.1111/trf.14561 -
Transfusion Clinique Et Biologique :... Sep 2018The severely decreased platelet counts (10-30.10 platelets/μL) frequently observed in patients undergoing chemotherapy, radiation treatment or organ transplantation are... (Review)
Review
The severely decreased platelet counts (10-30.10 platelets/μL) frequently observed in patients undergoing chemotherapy, radiation treatment or organ transplantation are associated with life-threatening increased bleeding risks. To circumvent these risks, platelet transfusion remains the treatment of choice, despite some limitations which include a limited shelf-life, storage-related deterioration, the development of alloantibodies in recipients and the transmission of infectious diseases. A sustained demand has evolved in recent years for controlled blood products, free of infectious, inflammatory and immune risks. As a consequence, the challenge for blood centers in the near future will be to ensure an adequate supply of blood platelets, which calls for a reassessment of our transfusion models. To meet this challenge, many laboratories are now turning their research efforts towards the in vitro and customized production of blood platelets.
Topics: Blood Platelets; Cell Culture Techniques; Humans; Megakaryocytes; Platelet Transfusion
PubMed: 30150135
DOI: 10.1016/j.tracli.2018.07.005 -
Transfusion and Apheresis Science :... Jun 2003Many patients with thrombocytopenia require transfusion of platelet concentrates, and numerous factors may influence the observed response to transfusion. One factor... (Review)
Review
Many patients with thrombocytopenia require transfusion of platelet concentrates, and numerous factors may influence the observed response to transfusion. One factor gaining growing recognition in recent years is the consideration of the dose of platelets to administer. Review of the available data regarding the effect of platelet dose on transfusion outcome is presented in this summary, with attention to those situations that seem to require higher platelet doses. Appropriate dosing may not only improve the immediate response to transfusion, but also lead to a decrease in further platelet transfusion requirements. Recommendations supported by actual clinical data are outlined, but controlled studies are needed to determine optimum platelet doses for many common clinical situations.
Topics: Blood Platelet Disorders; Humans; Platelet Count; Platelet Transfusion; Treatment Outcome
PubMed: 12725947
DOI: 10.1016/S1473-0502(03)00039-9 -
Australian and New Zealand Journal of... Dec 1993
Topics: Adult; Aged; Female; Gram-Positive Bacterial Infections; Humans; Male; Platelet Transfusion; Propionibacterium acnes
PubMed: 8141706
DOI: 10.1111/j.1445-5994.1993.tb04740.x -
Journal of Veterinary Emergency and... 2023To describe patient characteristics, underlying disease processes, clinical outcomes, transfusion dose and type (therapeutic or prophylactic), platelet count changes,...
Retrospective evaluation of fresh platelet concentrate administration in dogs: Patient characteristics, outcomes, and transfusion practices in 189 transfusion episodes (2008-2019).
OBJECTIVE
To describe patient characteristics, underlying disease processes, clinical outcomes, transfusion dose and type (therapeutic or prophylactic), platelet count changes, and adverse events associated with platelet concentrate (PC) administration in dogs.
DESIGN
Retrospective study.
SETTING
University teaching hospital.
ANIMALS
A total of 149 dogs, representing 189 PC transfusion episodes.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
In this population, 39 of 149 dogs (26.2%) were diagnosed with primary immune-mediated thrombocytopenia, 22 of 149 (14.8%) had decreased bone marrow production, 12 of 149 (8.0%) received PC during a massive transfusion, 3 of 149 (2.0%) had congenital thrombocytopathia, 59 of 149 (39.6%) had severe thrombocytopenia of other causes, and 14 of 149 (9.4%) underwent transfusion for miscellaneous causes without a documented severe thrombocytopenia. In 117 of 149 dogs (78.5%), >1 site of hemorrhage was noted. The most common sites of hemorrhage were the gastrointestinal (GI) tract in 89 of 149 (59.7%) and the skin in 78 of 149 (52.3%). Overall survival to discharge was 59.1% (88/149). The median PC dose was 0.8 units per 10 kg of body weight per transfusion episode (range: 0.2-6.7). Of 189 episodes, 29 of 189 (15.7%) were prophylactic, and 158 of 189 (83.6%) were therapeutic. For 99 of 189 transfusion episodes, paired pre- and postplatelet counts were available within 24 hours. The median platelet count change was 5.0 × 10 /L (5000/μL; range: -115 × 10 /L to 158 × 10 /L [-115,000 to 158,000/μL]); the posttransfusion platelet count was significantly higher than pretransfusion (P < 0.0001). The increase in platelet count after transfusion was greater in the prophylactic group than the therapeutic group (P = 0.0167). Transfusion reactions were suspected during 2 of 168 episodes (1.2%).
CONCLUSIONS
Immune-mediated thrombocytopenia was the most common disease process that resulted in PC transfusion. PC was more frequently administered to animals with active hemorrhage rather than prophylactically, and most dogs had evidence of hemorrhage in multiple organ systems, particularly the GI tract and skin. PC transfusions typically appeared safe, and the median platelet count increased after transfusion.
Topics: Dogs; Animals; Retrospective Studies; Hemorrhage; Thrombocytopenia; Platelet Count; Platelet Transfusion; Dog Diseases
PubMed: 36799875
DOI: 10.1111/vec.13281