A Computerized Prediction Model of Hazardous Inflammatory Platelet Transfusion Outcomes

Abstract

BackgroundPlatelet component (PC) transfusion leads occasionally to inflammatory hazards. Certain BRMs that are secreted by the platelets themselves during storage may have some responsibility.Methodology/Principal FindingsFirst, we identified non-stochastic arrangements of platelet-secreted BRMs in platelet components that led to acute transfusion reactions (ATRs). These data provide formal clinical evidence that platelets generate secretion profiles under both sterile activation and pathological conditions. We next aimed to predict the risk of hazardous outcomes by establishing statistical models based on the associations of BRMs within the incriminated platelet components and using decision trees. We investigated a large (n = 65) series of ATRs after platelet component transfusions reported through a very homogenous system at one university hospital. Herein, we used a combination of clinical observations, ex vivo and in vitro investigations, and mathematical modeling systems. We calculated the statistical association of a large variety (n = 17) of cytokines, chemokines, and physiologically likely factors with acute inflammatory potential in patients presenting with severe hazards. We then generated an accident prediction model that proved to be dependent on the level (amount) of a given cytokine-like platelet product within the indicated component, e.g., soluble CD40-ligand (>289.5 pg/109 platelets), or the presence of another secreted factor (IL-13, >0). We further modeled the risk of the patient presenting either a febrile non-hemolytic transfusion reaction or an atypical allergic transfusion reaction, depending on the amount of the chemokine MIP-1α (<20.4 or >20.4 pg/109 platelets, respectively).Conclusions/SignificanceThis allows the modeling of a policy of risk prevention for severe inflammatory outcomes in PC transfusion.

Thrombocytopenia and platelet transfusion in the neonate

“…Furthermore, an emerging hazard is characterized by an inflammatory response in the recipient. It is assumed that these reactions are triggered by pro-inflammatory factors, which are secreted by the platelets during storage or preparation [63]. Whether such an inflammatory response is responsible for the increased morbidity in neonates with NEC in the form of short bowel syndrome and/or liver dysfunction is unclear [64].…”

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

“…80 Although transfused PRBCs include microparticles and induce inflammation, platelet transfusions can induce approximately 3 times more reactions than do PRBC transfusions. 81 Vamvakas and Blajchman 82 have suggested that microparticles from platelets suppress immune response in recipients after transfusion. Thus, transfusion of platelets may both suppress the inflammatory response and induce an inflammatory reaction.…”

Transfusion et inflammation : hier – aujourd’hui – demain

“…De nombreuses études indiquent néanmoins que la majorité des incidents et accidents de nature bactérienne [53,54] mais aussi de nature inflammatoire (RFNH) survient en présence de CP délivrés entre j3 et j5 (et plus encore j7 lorsque ce délai est réglementairement autorisé) en lien direct avec une sécrétion accrue de BRM au-delà de j3, par les plaquettes elles-mêmes, même si ce point n'est pas retrouvé dans l'étude PLADO. L'accroissement de production de BRM par les plaquettes au-delà de 3 jours de conservation est, d'une part, spontanée (physiologique) mais elle peut être majorée par des stress de stockage et de conservation, infligeant des lésions [15,38,[55][56][57]. Le potentiel pro-inflammatoire des plaquettes homologues (allogéniques) transfusées est donc rapidement acquis.…”