-
Blood Transfusion = Trasfusione Del... Mar 2016Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related... (Review)
Review
Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly activated by collection through disposal equipment, which can stress the cells, and by preservation at 22 °C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4 °C. Lastly, platelets constitutively possess a very large number of bioactive components that may elicit pro-inflammatory reactions when infused into a patient. This review aims to describe approaches that may be crucial to minimising side effects while optimising safety and quality. We suggest that platelet transfusion is complex, in part because of the complexity of the "material" itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information showing--after years of exhaustive haemovigilance--that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (i.e. apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.
Topics: Blood Preservation; Blood Safety; Humans; Platelet Transfusion
PubMed: 26674828
DOI: 10.2450/2015.0042-15 -
Arteriosclerosis, Thrombosis, and... Jun 2023
Topics: Infant, Newborn; Humans; Platelet Transfusion; Hemostasis; Thrombocytopenia
PubMed: 37139838
DOI: 10.1161/ATVBAHA.123.319252 -
Deutsches Arzteblatt International Nov 2014The standard recommendation to date has been that acute hypoproliferative thrombocytopenia should be treated with a prophylactic platelet transfusion if the morning... (Review)
Review
BACKGROUND
The standard recommendation to date has been that acute hypoproliferative thrombocytopenia should be treated with a prophylactic platelet transfusion if the morning platelet count is less than 10 000/μL, or less than 20 000/μL if there are additional risk factors. For chronic thrombocytopenia, transfusion has been recommended if the platelet count is less than 5000/μL. In Germany, half a million platelet transfusions are now being given every year, and the number is rising. New studies indicate, however, that a more restrictive transfusion strategy is justified.
METHODS
A selective literature search was carried out in PubMed, with additional attention to recommendations from Germany and abroad, and to the guidelines of medical specialty societies.
RESULTS
Prophylactic platelet transfusions should be given when clinically indicated in consideration of the individual hemorrhagic risk. To prevent severe hemorrhage, it is more important to respond to the first signs of bleeding than to pay exclusive attention to morning platelet counts below 10 000/μL. This threshold value remains standard for patients with acute leukemia. According to recent studies, however, clinically stable patients who are at low risk for bleeding-e.g., patients who have undergone autologous hematopoietic stem-cell transplantation-may be well served by a therapeutic, rather than prophylactic, platelet transfusion strategy, in which platelets are transfused only when evidence of bleeding has been observed. For cancer patients, intensive-care patients, and patients with other risk factors, a clinically oriented transfusion strategy is recommended, in addition to close attention to threshold platelet values.
CONCLUSION
The number of platelet transfusions could be safely lowered by a more restrictive transfusion strategy that takes account of the risk of bleeding, as recommended in the hemotherapy guidelines.
Topics: Antineoplastic Agents; Evidence-Based Medicine; Germany; Hematology; Humans; Medical Oncology; Neoplasms; Platelet Transfusion; Postoperative Hemorrhage; Practice Guidelines as Topic; Thrombocytopenia; Treatment Outcome
PubMed: 25512006
DOI: 10.3238/arztebl.2014.0809 -
Journal of the Royal College of... 1998The statement printed below was agreed at a consensus conference on platelet transfusion organised by the Royal College of Physicians of Edinburgh and held in Edinburgh...
The statement printed below was agreed at a consensus conference on platelet transfusion organised by the Royal College of Physicians of Edinburgh and held in Edinburgh in November 1997. We publish this statement at the request of the organising committee to bring it to the attention of physicians who do not read the haematological literature. The statement will also appear in the British Journal of Haematology in 1998 with the scientific evidence upon which it is based.
Topics: Blood Platelet Disorders; Contraindications; Humans; Platelet Transfusion; Practice Guidelines as Topic; Quality Control; United Kingdom
PubMed: 9597636
DOI: No ID Found -
Current Opinion in Hematology Nov 2019In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of... (Review)
Review
PURPOSE OF REVIEW
In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets.
RECENT FINDINGS
Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study.
SUMMARY
Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.
Topics: ABO Blood-Group System; Age Factors; Child; Disease Management; Disease Susceptibility; Hemorrhage; Humans; Infant, Newborn; Platelet Transfusion; Thrombocytopenia
PubMed: 31503020
DOI: 10.1097/MOH.0000000000000542 -
Platelets Dec 2023Extracellular vesicles (EVs) contain the characteristics of their cell of origin and mediate cell-to-cell communication. Platelet-derived extracellular vesicles (PEVs)... (Review)
Review
Extracellular vesicles (EVs) contain the characteristics of their cell of origin and mediate cell-to-cell communication. Platelet-derived extracellular vesicles (PEVs) not only have procoagulant activity but also contain platelet-derived inflammatory factors (CD40L and mtDNA) that mediate inflammatory responses. Studies have shown that platelets are activated during storage to produce large amounts of PEVs, which may have implications for platelet transfusion therapy. Compared to platelets, PEVs have a longer storage time and greater procoagulant activity, making them an ideal alternative to platelets. This review describes the reasons and mechanisms by which PEVs may have a role in blood transfusion therapy.
Topics: Humans; Blood Platelets; Platelet Transfusion; Extracellular Vesicles; Blood Transfusion
PubMed: 37578045
DOI: 10.1080/09537104.2023.2242708 -
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 -
Platelet Transfusion Practice and Related Outcomes in Pediatric Extracorporeal Membrane Oxygenation.Pediatric Critical Care Medicine : a... Feb 2020To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion,...
OBJECTIVE
To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion, complications, and mortality.
DESIGN
Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.
SETTING
Eight Collaborative Pediatric Critical Care Research Network-affiliated hospitals.
PATIENTS
Age less than 19 years old and treated with extracorporeal membrane oxygenation.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Of 511 children, 496 (97.1%) received at least one platelet transfusion during extracorporeal membrane oxygenation. Neonatal age, venoarterial extracorporeal membrane oxygenation, and various acute and chronic diagnoses were associated with increased average daily platelet transfusion volume (milliliters per kilogram body weight). On multivariable analysis, average daily platelet transfusion volume was independently associated with mortality (per 1 mL/kg; odds ratio, 1.05; CI, 1.03-1.08; p < 0.001), whereas average daily platelet count was not (per 1 × 10/L up to 115 × 10/L; odds ratio, 1.00; CI, 0.98-1.01; p = 0.49). Variables independently associated with increased daily bleeding risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day, a primary cardiac indication for extracorporeal membrane oxygenation, adolescent age, and an acute diagnosis of congenital cardiovascular disease. Variables independently associated with increased daily thrombotic risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day and venoarterial extracorporeal membrane oxygenation. Variables independently associated with decreased daily thrombotic risk included full-term neonatal age and an acute diagnosis of airway abnormality.
CONCLUSIONS
Platelet transfusion was common in this multisite pediatric extracorporeal membrane oxygenation cohort. Platelet transfusion volume was associated with increased risk of mortality, bleeding, and thrombosis.
Topics: Acute Disease; Adolescent; Age Factors; Child; Child, Preschool; Chronic Disease; Extracorporeal Membrane Oxygenation; Hemorrhage; Hospital Mortality; Humans; Infant; Infant, Newborn; Logistic Models; Odds Ratio; Platelet Count; Platelet Transfusion; Prospective Studies; Risk Factors; Treatment Outcome
PubMed: 31568245
DOI: 10.1097/PCC.0000000000002102 -
Deutsches Arzteblatt International Jul 2015
Topics: Antineoplastic Agents; Humans; Neoplasms; Platelet Transfusion; Postoperative Hemorrhage; Thrombocytopenia
PubMed: 26249253
DOI: 10.3238/arztebl.2015.0505a -
Current Opinion in Hematology Nov 2021Platelet transfusion can be life-saving but carries a risk of infection or alloimmunization and is limited by insufficient donor sources and restricted unit shelf life.... (Review)
Review
PURPOSE OF REVIEW
Platelet transfusion can be life-saving but carries a risk of infection or alloimmunization and is limited by insufficient donor sources and restricted unit shelf life. Generating sufficient platelets in vitro to replace a unit of collected blood remains a challenge. Here, we examine the latest advances in the regulation of megakaryocyte maturation and expansion along with platelet formation and survival. We also discuss alternative therapies investigated to induce platelet production.
RECENT FINDINGS
Recent studies examined candidate niche cells in the bone marrow microenvironment for promoting platelet formation and developed an explant-based bioreactor to enhance platelet production ex vivo. Chemical inhibitors were examined for their ability to promote megakaryocyte maturation and expansion. Microparticles from megakaryocytes or platelets were found to improve megakaryocyte maturation and platelet formation. Membrane budding was identified as a novel mode of platelet formation. Lastly, a chemical inhibitor to improve cold-stored platelets was identified.
SUMMARY
Recent advances in the regulation of megakaryocyte expansion and platelet production provide exciting promise for the development of improved approaches to generate platelets in vitro. These findings bring the field one step closer to achieving the ultimate goal of creating a unit of platelets without the need for donation.
Topics: Blood Platelets; Bone Marrow; Humans; Megakaryocytes; Platelet Transfusion; Thrombopoiesis
PubMed: 34232141
DOI: 10.1097/MOH.0000000000000662