Effect of platelet storage duration on clinical outcomes and incremental platelet change in critically ill children

Abstract

Background The safety of platelet (PLT) concentrates with longer storage duration has been questioned due to biochemical and functional changes that occur during blood collection and storage. Some studies have suggested that transfusion efficacy is decreased and immune system dysfunction is worsened with increased storage age. We sought to describe the effect of PLT storage age on laboratory and clinical outcomes in critically ill children receiving PLT transfusions. Study Design and Methods: We performed a secondary analysis of a prospective, observational point-prevalence study. Children (3 days to 16 years of age) from 82 pediatric intensive care units in 16 countries were enrolled if they received a PLT transfusion during one of the predefined screening weeks. Outcomes (including PLT count increments, organ dysfunction, and transfusion reactions) were evaluated by PLT storage age. Results: Data from 497 patients were analyzed. The age of the PLT transfusions ranged from 1 to 7 days but the majority were 4 (24%) or 5 (36%) days of age. Nearly two-thirds of PLT concentrates were transfused to prevent bleeding. The indication for transfusion did not differ between storage age groups Abbreviations: IQR, interquartile range; PICU, pediatric intensive care unit. †The P 3 T investigators are listed in the acknowledgements.

Aged versus fresh autologous platelet transfusion in a two‐hit healthy volunteer model of transfusion‐related acute lung injury

“…Two small randomized studies on PC storage duration found no TRALI cases, but were likely underpowered to find any, as their focus was on platelet count increment and transfusion intervals 23,24 . An individual patient data meta‐analysis of PC storage duration found no relation with in‐hospital mortality, 36 and neither did two retrospective and one prospective cohort study 37–39 …”

“…23,24 An individual patient data meta-analysis of PC storage duration found no relation with in-hospital mortality, 36 and neither did two retrospective and one prospective cohort study. [37][38][39] Intervention Saline Fresh Platelets Aged Platelets F I G U R E 3 Blood cell counts and inflammatory biomarkers changed after infusion of lipopolysaccharide. The light gray area represents the time before transfusion, and the dark gray area represents the time after transfusion.…”

Transfusion practices in a large cohort of hospitalized children

“…Likewise, the importance of storage duration of platelets is unclear. 29 Though metabolomic changes have been described with increasing irradiation storage duration, it is unclear if the transfusion of aged platelets has clinical repercussions. 30 Infants and children in our cohort were more likely to be transfused single products in the ICU and general ward and multiple products in the OR.…”

“…In our cohort, slightly more than half of infants and children were transfused with ABO identical platelets, demonstrating a population in which equipoise exists to explore this clinical question. Likewise, the importance of storage duration of platelets is unclear 29 . Though metabolomic changes have been described with increasing irradiation storage duration, it is unclear if the transfusion of aged platelets has clinical repercussions 30 …”

“…For the entire cohort, the median (interquartile range) pretransfusion laboratory values were as follows: hemoglobin, 7.9 g/dl (7.1-10.4 g/dl); platelet count, 27 Â 10 9 cells/L (14-54 Â 10 9 cells/L); and international normalized ratio was 1.6 (1.4-2.0). Recipient age differences were observed in the frequency of RBC irradiation (95% in infants, 67% in children, p < .001) and storage duration of RBC transfusions (median storage duration of 12 [8][9][10][11][12][13][14][15][16][17] days in infants and 20 [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] days in children, p < .001).…”