Duration of platelet storage and outcomes of critically ill patients

Flint, Andrew W. J.; Aubron, Cécile; Bailey, Michael; Bellomo, Rinaldo; Pilcher, David; Cheng, Allen; Hegarty, Colin; Reade, Michael C.; McQuilten, Zoe

doi:10.1111/trf.14056

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…To our knowledge, no study has investigated the association between transfusion efficacy and platelet storage duration in critically ill patients. Five observational studies have investigated the association between PC storage duration and critically ill patient outcomes; one included post-cardiac surgery patients only, two studies included trauma patients only, and two all critically ill patients ( 69 – 73 ). There was no association between mortality and storage duration in the three studies evaluating this outcome ( 69 , 70 , 73 ).…”

Section: Platelet Storage and Outcomes Of Critically Ill Patientsmentioning

confidence: 99%

“…Five observational studies have investigated the association between PC storage duration and critically ill patient outcomes; one included post-cardiac surgery patients only, two studies included trauma patients only, and two all critically ill patients ( 69 – 73 ). There was no association between mortality and storage duration in the three studies evaluating this outcome ( 69 , 70 , 73 ). In a study of 381 trauma patients, those receiving platelets stored for 5 days developed more complications, including sepsis, than patients transfused with platelets stored for less than 5 days (5.5% sepsis in patients receiving platelets stored for 3 days or less, versus 16.7% in patients receiving platelets stored for 5 days, p = 0.03) ( 70 ).…”

Section: Platelet Storage and Outcomes Of Critically Ill Patientsmentioning

confidence: 99%

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The Non-Hemostatic Aspects of Transfused Platelets

et al. 2018

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Platelets transfusion is a safe process, but during or after the process, the recipient may experience an adverse reaction and occasionally a serious adverse reaction (SAR). In this review, we focus on the inflammatory potential of platelet components (PCs) and their involvement in SARs. Recent evidence has highlighted a central role for platelets in the host inflammatory and immune responses. Blood platelets are involved in inflammation and various other aspects of innate immunity through the release of a plethora of immunomodulatory cytokines, chemokines, and associated molecules, collectively termed biological response modifiers that behave like ligands for endothelial and leukocyte receptors and for platelets themselves. The involvement of PCs in SARs—particularly on a critically ill patient’s context—could be related, at least in part, to the inflammatory functions of platelets, acquired during storage lesions. Moreover, we focus on causal link between platelet activation and immune-mediated disorders (transfusion-associated immunomodulation, platelets, polyanions, and bacterial defense and alloimmunization). This is linked to the platelets’ propensity to be activated even in the absence of deliberate stimuli and to the occurrence of time-dependent storage lesions.

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Section: Platelet Storage and Outcomes Of Critically Ill Patientsmentioning

confidence: 99%

Section: Platelet Storage and Outcomes Of Critically Ill Patientsmentioning

confidence: 99%

The Non-Hemostatic Aspects of Transfused Platelets

et al. 2018

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“…Several observational studies in non-critically ill hematology patients reported improved post-transfusion increments when using fresh platelet concentrates stored for less than 3 days, though without any significant impact on the further incidence of bleeding events. [27][28][29][30][31] Finally, how may the present findings translate into improvement in platelet transfusion practices in the ICU? Few factors are likely amenable to specific interventions to improve the efficacy of transfusions, by increasing the dose of transfused platelets, and maybe controlling fever and avoiding thrombocytotoxic antibiotics.…”

Section: Discussionmentioning

confidence: 94%

Post‐transfusion platelet responses in critically ill cancer patients with hypoproliferative thrombocytopenia

et al. 2019

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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 singlecenter 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.

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“…The time limitation is attributed to the occasional observation that particularly older platelets bear an increasing risk of bacterial transmission [11, 23]. These reports are, however, contradicted by publications questioning the strict correlation between the transfusion of older platelets and sepsis [24, 25]. A comprehensive literature review by Aubron et al [26] revealed, that only 1 of 5 studies confirmed the assumption of an increased sepsis risk by the administration of older platelets.…”

Section: Risk Mitigation Through Platelet Storage Limitationmentioning

confidence: 97%

Microbiological Screening of Platelet Concentrates in Europe

Prax

Bekeredjian‐Ding

Krut³

2019

Transfus Med Hemother

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The risk of transfusion-associated sepsis due to transmission of bacteria is a persistent problem in the transfusion field. Despite numerous interventions to reduce the risk, cases of bacterial sepsis following transfusion are repeatedly being reported. Especially platelet concentrates are highly susceptible to bacterial contaminations due to the growth-promoting storage conditions. In Europe, blood establishments and national authorities have implemented individual precaution measures to mitigate the risk of bacterial transmission. To obtain an overview of the different approaches, we compiled information from national authorities, blood establishments, and the current literature. Several aspects such as the shelf life of platelets, time of sampling and the applied control measures are compared between the member states. The analysis of the data revealed a broad heterogeneity of procedures on a national level ranging from platelet release without any safety testing up to mandatory screening of all platelet concentrates prior to transfusion. Despite the substantial progress made in recent years, several bacterial reports on transfusion-associated sepsis indicate that further efforts are needed to increase the safety of blood transfusions in the long term.

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Duration of platelet storage and outcomes of critically ill patients

Abstract: In this large observational study in a heterogeneous ICU population, storage duration of PLTs was not associated with an increased risk of mortality or infection.

Cited by 9 publications

References 17 publications

The Non-Hemostatic Aspects of Transfused Platelets

The Non-Hemostatic Aspects of Transfused Platelets

Post‐transfusion platelet responses in critically ill cancer patients with hypoproliferative thrombocytopenia

Microbiological Screening of Platelet Concentrates in Europe

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