A multicenter randomized study of the efficacy of transfusions with platelets stored in platelet additive solution II versus plasma

Abstract

Randomized studies testing the clinical efficacy of platelet additive solutions (PASs) for storage of platelets are scarce and often biased by patient selection. We conducted a multicenter, randomized study to investigate clinical efficacy of platelets stored in PAS II versus plasma, also including patients with clinical complications associated with increased platelet consumption. A total of 168 evaluable patients received pooled buffy coatderived platelet concentrates (PCs) suspended in either plasma (n ‫؍‬ 354) or PAS II (n ‫؍‬ 411) stored up to 5 days. Both univariate as well as multivariate analysis showed a significant effect of used storage medium in regard to 1-and 24-hour count increments and corrected count increments, in favor of plasma PCs. However, there were no significant differences between the groups regarding bleeding complications and transfusion interval. Adverse transfusion reactions occurred significantly less after transfusions with PAS II PCs (P ‫؍‬ .04). Multivariate analysis showed no significant effect of the used storage medium on the incidence of 1-and 24-hour transfusion failure. We showed safety and efficacy of PAS II PCs in intensively treated patients; however, plasma PCs show superior increments. (Blood. 2006;108:3210-3215)

Clinical effectiveness of leucoreduced, pooled donor platelet concentrates, stored in plasma or additive solution with and without pathogen reduction

“…PCs were prepared from five pooled whole-blood buffy-coats (BC) with the same ABO-blood group using standard procedures and with regard to pathogen reduction using manufacturer's instructions (van Rhenen et al, 2003;Kerkhoffs et al, 2006). Samples were obtained prior to storage to measure platelet content.…”

“…The S-59 Platelet Recovery in Thrombocytopenia in Europe (EuroSPRITE) trial (103 patients) reported no significant differences with regard to transfusion efficacy, however the control arm of this study used buffy-coat derived platelets stored in plasma as well as in additive solution (PASII) for approximately half of the transfusions (van Rhenen et al, 2003). In a previous randomized clinical trial (RCT) we showed that PASII PC have a 20% lower corrected count increment (CCI) as compared to plasma PC, which might mask a relevant difference (Kerkhoffs et al, 2006). A third small trial with 43 patients showed a borderline significant reduction in transfusion efficacy (Janetzko et al, 2005).…”

“…If available, ABO-identical PC were used, although minor-and major incompatible PC were not excluded. Platelet transfusion failure was defined as a 1-h CCI below 7AE5 and/or and 24-h CCI below 4AE5 (Kerkhoffs et al, 2006). Immunological refractoriness was defined as the occurrence of transfusion failure of two consecutive ABOmatched random platelet transfusions combined with the existence of HLA-and/or HPA-alloantibodies.…”

Plateletpheresis: the Process, Devices, and Indicators of Product Quality

“…It has been observed that alloimmunized patients have difficulty managing their thrombocytopenia after platelet transfusion, and are refractory to fresh allogeneic platelets [42,60]. Additionally, some studies have found decreased CCI values using platelet additive solution (PAS), and further, it has been observed that all patients who were refractory to fresh allogeneic platelet transfusion had successful CCI results to autologous cryopreserved platelets [16,29,60]. Table 3 presents the transfusion efficacy of apheresis platelets according to different approaches to apheresis, which showed that the successful platelet transfusion in all apheresis instruments.…”

“…In a quality comparison of extended platelet storage (up to 9 days) using the different Trima systems, it was found that platelets collected in PAS were more likely to retain acceptable metabolic and cellular characteristics than platelets collected in plasma-stored apheresis units [26]. However, some studies have reported that platelets suspended in PAS show significantly lower CCI than platelets suspended in plasma [16,29]. Table 4 presents details of the changes in metabolic activity of apheresis platelet according to the use of different additive solutions when the same device is used [18,26,45].…”