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Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Chawla S, Castro P, Povoa P, Coelho L, Metaxa V, Kochanek M, Liebregts T, Kander T, Sivula M, Andreasen JB, Nielsen LB, Hvas CL, Dufranc E, Canet E, Wright CJ, Schmidt J, Uhel F, Missri L, Krag M, Cos Badia E, Díaz-Lagares C, Menat S, Voiriot G, Erikstrup Clausen N, Lorentzen K, Kvåle R, Barratt-Due A, Hildebrandt T, Holten AR, Strand K, Bestle MH, Klepstad P, Vimpere D, Paulino C, Lueck C, Juhl CS, Costa C, Bådstøløkken PM, Lêdo LSA, Møller MH, Russell L. Platelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study. Acta Anaesthesiol Scand 2024. [PMID: 38840310 DOI: 10.1111/aas.14467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Platelet transfusions are frequently used in the intensive care unit (ICU), but current practices including used product types, volumes, doses and effects are unknown. STUDY DESIGN AND METHODS Sub-study of the inception cohort study 'Thrombocytopenia and Platelet Transfusions in the ICU (PLOT-ICU)', including acutely admitted, adult ICU patients with thrombocytopenia (platelet count <150 × 109/L). The primary outcome was the number of patients receiving platelet transfusion in ICU by product type. Secondary outcomes included platelet transfusion details, platelet increments, bleeding, other transfusions and mortality. RESULTS Amongst 504 patients with thrombocytopenia from 43 hospitals in 10 countries in Europe and the United States, 20.8% received 565 platelet transfusions; 61.0% received pooled products, 21.9% received apheresis products and 17.1% received both with a median of 2 (interquartile range 1-4) days from admission to first transfusion. The median volume per transfusion was 253 mL (180-308 mL) and pooled products accounted for 59.1% of transfusions, however, this varied across countries. Most centres (73.8%) used fixed dosing (medians ranging from 2.0 to 3.5 × 1011 platelets/transfusion) whilst some (mainly in France) used weight-based dosing (ranging from 0.5 to 0.7 × 1011 platelets per 10 kg body weight). The median platelet count increment for a single prophylactic platelet transfusion was 2 (-1 to 8) × 109/L. Outcomes of patients with thrombocytopenia who did and did not receive platelet transfusions varied. CONCLUSIONS Among acutely admitted, adult ICU patients with thrombocytopenia, 20.8% received platelet transfusions in ICU of whom most received pooled products, but considerable variation was observed in product type, volumes and doses across countries. Prophylactic platelet transfusions were associated with limited increases in platelet counts.
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Affiliation(s)
- Carl Thomas Anthon
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frédéric Pène
- Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Elie Azoulay
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Kathryn Puxty
- Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Andry Van De Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Povoa
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Luis Coelho
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Liebregts
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mirka Sivula
- Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Coagulation Disorders Unit, Department of Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jo Bønding Andreasen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | | | - Christine Lodberg Hvas
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Etienne Dufranc
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Emmanuel Canet
- Médecine Intensive Réanimation, CHU de Nantes, Université de Nantes, Nantes, France
| | | | - Julien Schmidt
- Service de réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Fabrice Uhel
- Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Paris, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Paris, France
| | - Louai Missri
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Mette Krag
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Elisabet Cos Badia
- Department of Intensive Care, Hospital General Granollers, Barcelona, Spain
| | - Cándido Díaz-Lagares
- Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sophie Menat
- Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Paris, France
| | - Niels Erikstrup Clausen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Lorentzen
- Department of Intensive Care, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Reidar Kvåle
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Andreas Barratt-Due
- Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Thomas Hildebrandt
- Department of Intensive Care, Zealand University Hospital - Roskilde, Roskilde, Denmark
| | - Aleksander Rygh Holten
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Morten Heiberg Bestle
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Pål Klepstad
- Department of Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway
| | - Damien Vimpere
- Médecine Intensive & Réanimation, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Carolina Paulino
- Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Catherina Lueck
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christian Svendsen Juhl
- Department of Anaesthesiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Carolina Costa
- Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | | | - Lia Susana Aires Lêdo
- Department of Intensive Care Medicine - Unit 2, Hospital Egas Moniz - CHLO, EPE, Lisbon, Portugal
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
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2
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Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Chawla S, Castro P, Povoa P, Coelho L, Metaxa V, Kochanek M, Liebregts T, Kander T, Sivula M, Møller MH, Russell L. Platelet transfusions in adult thrombocytopenic ICU patients: Protocol for a sub-study of the PLOT-ICU cohort. Acta Anaesthesiol Scand 2024; 68:434-440. [PMID: 38115558 DOI: 10.1111/aas.14365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Platelet transfusions are frequently used in intensive care unit (ICU) patients, but contemporary epidemiological data are sparse. We aim to present contemporary international data on the use of platelet transfusions in adult ICU patients with thrombocytopenia. METHODS This is a protocol and statistical analysis plan for a post hoc sub-study of 504 thrombocytopenic patients from the 'Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU)'. The primary outcome will be the number of patients receiving platelet transfusion in the ICU reported according to the type of product received (apheresis-derived versus pooled whole-blood-derived transfusions). Secondary platelet transfusion outcomes will include platelet transfusion volumes; timing of platelet transfusion; approach to platelet transfusion dosing (fixed dosing versus weight-based dosing) and platelet count increments for prophylactic transfusions. Secondary clinical outcomes will include the number of patients receiving red blood cell- and plasma transfusions during ICU stay; the number of patients who bled in the ICU, the number of patients who had a new thrombosis in the ICU, and the number of patients who died. The duration of follow-up was 90 days. Baseline characteristics and secondary clinical outcomes will be stratified according to platelet transfusion status in the ICU and severity of thrombocytopenia. Data will be presented descriptively. CONCLUSIONS The outlined study will provide detailed epidemiological data on the use of platelet transfusions in adult ICU patients with thrombocytopenia using data from the large international PLOT-ICU cohort study. The findings will inform the design of future randomised trials evaluating platelet transfusions in ICU patients.
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Affiliation(s)
- Carl Thomas Anthon
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Frédéric Pène
- Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Elie Azoulay
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Kathryn Puxty
- Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Andry Van De Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Povoa
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Luis Coelho
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Liebregts
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mirka Sivula
- Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Coagulation Disorders Unit, Department of Hematology, Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France
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3
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Lu J, Karkouti K, Peer M, Englesakis M, Spinella PC, Apelseth TO, Scorer TG, Kahr WHA, McVey M, Rao V, Abrahamyan L, Lieberman L, Mewhort H, Devine DV, Callum J, Bartoszko J. Cold-stored platelets for acute bleeding in cardiac surgical patients: a narrative review. Can J Anaesth 2023; 70:1682-1700. [PMID: 37831350 DOI: 10.1007/s12630-023-02561-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/19/2023] [Accepted: 04/30/2023] [Indexed: 10/14/2023] Open
Abstract
PURPOSE Cold-stored platelets (CSP) are an increasingly active topic of international research. They are maintained at 1-6 °C, in contrast to standard room-temperature platelets (RTP) kept at 20-24 °C. Recent evidence suggests that CSP have superior hemostatic properties compared with RTP. This narrative review explores the application of CSP in adult cardiac surgery, summarizes the preclinical and clinical evidence for their use, and highlights recent research. SOURCE A targeted search of MEDLINE and other databases up to 24 February 2022 was conducted. Search terms combined concepts such as cardiac surgery, blood, platelet, and cold-stored. Searches of trial registries ClinicalTrials.gov and WHO International Clinical Trials Registry Platform were included. Articles were included if they described adult surgical patients as their population of interest and an association between CSP and clinical outcomes. References of included articles were hand searched. PRINCIPAL FINDINGS When platelets are stored at 1-6 °C, their metabolic rate is slowed, preserving hemostatic function for increased storage duration. Cold-stored platelets have superior adhesion characteristics under physiologic shear conditions, and similar or superior aggregation responses to physiologic agonists. Cold-stored platelets undergo structural, metabolic, and molecular changes which appear to "prime" them for hemostatic activity. While preliminary, clinical evidence supports the conduct of trials comparing CSP with RTP for patients with platelet-related bleeding, such as those undergoing cardiac surgery. CONCLUSION Cold-stored platelets may have several advantages over RTP, including increased hemostatic capacity, extended shelf-life, and reduced risk of bacterial contamination. Large clinical trials are needed to establish their potential role in the treatment of acutely bleeding patients.
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Affiliation(s)
- Justin Lu
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Miki Peer
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Marina Englesakis
- Library & Information Services, University Health Network, Toronto, ON, Canada
| | - Philip C Spinella
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Torunn O Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
- Norwegian Armed Forces Joint Medical Services, Norwegian Armed Forces, Oslo, Norway
| | - Thomas G Scorer
- Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Walter H A Kahr
- Division of Haematology/Oncology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada
- Departments of Paediatrics and Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Mark McVey
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Department of Physics, Toronto Metropolitan University, Toronto, ON, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lusine Abrahamyan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto General Research Institute, Toronto, ON, Canada
| | - Lani Lieberman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Holly Mewhort
- Department of Surgery, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Jeannie Callum
- Quality in Utilization, Education and Safety in Transfusion Research Program, University of Toronto, Toronto, ON, Canada
- Department of Pathology and Molecular Medicine, School of Medicine, Queen's University, Kingston, ON, Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Kingston, ON, Canada
| | - Justyna Bartoszko
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Sinai Health System, Women's College Hospital, University Health Network, Toronto General Hospital, 200 Elizabeth Street, 3EN-464, Toronto, ON, M5G 2C4, Canada.
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Liker M, Bašić Kinda S, Duraković N, Bojanić I, Aurer I, Golubić Ćepulić B. The appropriateness of platelet transfusions in hematological patients and the potential for improvement. Transfus Clin Biol 2022; 30:212-218. [PMID: 36493919 DOI: 10.1016/j.tracli.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hematology patients are intensive platelet users. In clinical practice, a substantial proportion of platelet (PLT) transfusions are routinely administered outside the guidelines despite compelling evidence for recommendations. Those unnecessary PLT transfusions are an unjustified extra burden on a scarce healthcare resource and may also be detrimental to the patients. This study aims to evaluate indications and assess the appropriateness of PLT transfusion, as well as to identify common discrepancies and propose modalities for better compliance with guidelines. MATERIAL AND METHODS The audit of all PLT orders for adult hematological inpatients was conducted over 2 months. The assessment was performed using guidelines for PLT transfusion. Patient demographic, clinical, and transfusion data were collected from hospital electronic medical records. RESULTS Based on 286 PLT orders, 344 PCs were transfused to 67 patients: 235 (82.2%) prophylactical due to low PLT count, 34 (11.9%) preprocedural and 17 (5.9%) therapeutic. Overall, 105 (36.77%) PLT transfusions were inappropriate: 78 (33.2%) of all prophylactic PLT transfusions due to low PLT count, 17 (50%) off all preprocedural and 10 (58.8%) of all therapeutical transfusion. The major reason for PLT transfusion inappropriateness was transfusion above the recommended threshold. Double units of PCs were transfused in 36.7% of all PLT transfusions and 32.4% of them were considered inappropriate. CONCLUSION Our audit of PLT transfusion practice found a large proportion of inappropriate PLT transfusions. Based on the most common deviations from the guidelines a variety of targeted measures for improvement are proposed.
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Affiliation(s)
- Milica Liker
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Sandra Bašić Kinda
- Division of Hematology, Department of Internal Medicine, Zagreb, University Hospital Centre Zagreb, Croatia
| | - Nadira Duraković
- Division of Hematology, Department of Internal Medicine, Zagreb, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia
| | - Ines Bojanić
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia
| | - Igor Aurer
- Division of Hematology, Department of Internal Medicine, Zagreb, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia
| | - Branka Golubić Ćepulić
- Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia; Division of Hematology, Department of Internal Medicine, Zagreb, University Hospital Centre Zagreb, Croatia; School of Medicine, University of Zagreb, Croatia; University of Applied Health Sciences, Zagreb, Croatia
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5
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Yousuf B, Pasha R, Pineault N, Ramirez‐Arcos S. Contamination of platelet concentrates with
Staphylococcus aureus
induces significant modulations in platelet functionality. Vox Sang 2022; 117:1318-1322. [DOI: 10.1111/vox.13353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Basit Yousuf
- Medical Affairs and Innovation Canadian Blood Services Ottawa Ontario Canada
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Roya Pasha
- Medical Affairs and Innovation Canadian Blood Services Ottawa Ontario Canada
| | - Nicolas Pineault
- Medical Affairs and Innovation Canadian Blood Services Ottawa Ontario Canada
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
| | - Sandra Ramirez‐Arcos
- Medical Affairs and Innovation Canadian Blood Services Ottawa Ontario Canada
- Department of Biochemistry, Microbiology and Immunology University of Ottawa Ottawa Ontario Canada
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6
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There and Back Again: The Once and Current Developments in Donor-Derived Platelet Products for Products for Hemostatic Therapy. Blood 2022; 139:3688-3698. [PMID: 35482959 DOI: 10.1182/blood.2021014889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/20/2022] [Indexed: 01/19/2023] Open
Abstract
Over 100 years ago, Duke transfused whole blood to a thrombocytopenic patient to raise the platelet count and prevent bleeding. Since then, platelet transfusions have undergone numerous modifications from whole blood-derived platelet-rich plasma to apheresis-derived platelet concentrates. Similarly, the storage time and temperature have changed. The mandate to store platelets for a maximum of 5-7 days at room temperature has been challenged by recent clinical trial data, ongoing difficulties with transfusion-transmitted infections, and recurring periods of shortages, further exacerbated by the COVID-19 pandemic. Alternative platelet storage approaches are as old as the first platelet transfusions. Cold-stored platelets may offer increased storage times (days) and improved hemostatic potential at the expense of reduced circulation time. Frozen (cryopreserved) platelets extend the storage time to years but require storage at -80 °C and thawing before transfusion. Lyophilized platelets can be powder-stored for years at room temperature and reconstituted within minutes in sterile water but are probably the least explored alternative platelet product to date. Finally, whole blood offers the hemostatic spectrum of all blood components but has challenges, such as ABO incompatibility. While we know more than ever before about the in vitro properties of these products, clinical trial data on these products are accumulating. The purpose of this review is to summarize the findings of recent preclinical and clinical studies on alternative, donor-derived platelet products.
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7
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Arnason NA, Johannsson F, Landrö R, Hardarsson B, Gudmundsson S, Lian AM, Reseland J, Rolfsson O, Sigurjonsson OE. Protein Concentrations in Stored Pooled Platelet Concentrates Treated with Pathogen Inactivation by Amotosalen Plus Ultraviolet a Illumination. Pathogens 2022; 11:pathogens11030350. [PMID: 35335674 PMCID: PMC8954553 DOI: 10.3390/pathogens11030350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Platelet granules contain a diverse group of proteins. Upon activation and during storage, platelets release a number of proteins into the circulation or supernatant of stored platelet concentrate (PC). The aim of this work was to investigate the effect of pathogen inactivation (PI) on a selection of proteins released in stored platelets. Materials and Methods: PCs in platelet additive solution (PAS) were produced from whole blood donations using the buffy coat (BC) method. PCs in the treatment arm were pathogen inactivated with amotosalen and UVA, while PCs in the second arm were used as an untreated platelet control. Concentrations of 36 proteins were monitored in the PCs during storage. Results: The majority of proteins increased in concentration over the storage period. In addition, 10 of the 29 proteins that showed change had significantly different concentrations between the PI treatment and the control at one or more timepoints. A subset of six proteins displayed a PI-related drop in concentration. Conclusions: PI has limited effect on protein concentration stored PC supernatant. The protein’s changes related to PI treatment with elevated concentration implicate accelerated Platelet storage lesion (PSL); in contrast, there are potential novel benefits to PI related decrease in protein concentration that need further investigation.
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Affiliation(s)
- Niels Arni Arnason
- The Blood Bank, Landspitali-The National University Hospital of Iceland, 105 Reykjavik, Iceland; (N.A.A.); (R.L.); (B.H.); (S.G.)
- School of Engineering, Reykjavik University, 105 Reykjavik, Iceland
| | - Freyr Johannsson
- Department of Medicine, University of Iceland, 105 Reykjavik, Iceland; (F.J.); (O.R.)
| | - Ragna Landrö
- The Blood Bank, Landspitali-The National University Hospital of Iceland, 105 Reykjavik, Iceland; (N.A.A.); (R.L.); (B.H.); (S.G.)
| | - Björn Hardarsson
- The Blood Bank, Landspitali-The National University Hospital of Iceland, 105 Reykjavik, Iceland; (N.A.A.); (R.L.); (B.H.); (S.G.)
| | - Sveinn Gudmundsson
- The Blood Bank, Landspitali-The National University Hospital of Iceland, 105 Reykjavik, Iceland; (N.A.A.); (R.L.); (B.H.); (S.G.)
| | - Aina-Mari Lian
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, 0317 Oslo, Norway; (A.-M.L.); (J.R.)
| | - Janne Reseland
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, 0317 Oslo, Norway; (A.-M.L.); (J.R.)
| | - Ottar Rolfsson
- Department of Medicine, University of Iceland, 105 Reykjavik, Iceland; (F.J.); (O.R.)
| | - Olafur E. Sigurjonsson
- The Blood Bank, Landspitali-The National University Hospital of Iceland, 105 Reykjavik, Iceland; (N.A.A.); (R.L.); (B.H.); (S.G.)
- School of Engineering, Reykjavik University, 105 Reykjavik, Iceland
- Correspondence: ; Tel.: +354-543-5523 or +354-694-9427; Fax: +354-543-5532
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8
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Abstract
Platelets are commonly transfused either therapeutically or prophylactically to maintain hemostasis. Most platelet transfusions are used to manage patients with hematologic malignancies. Although platelet transfusion guidelines have been published, platelet transfusion practices are still heterogeneous. Platelet transfusion guidelines partly lack recommendations or differ in the platelet threshold recommendations in some clinical situations. This article reviews platelet transfusions focusing on transfusion guidelines and platelet thresholds in different clinical settings.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010-3000, USA
| | - Zaher K Otrock
- Division of Transfusion Medicine, Department of Pathology and Laboratory Medicine, Henry Ford Hospital, K6, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA.
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9
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Tohidi-Esfahani I, Tan S, Tan CW, Johnson L, Marks DC, Chen VM. Platelet procoagulant potential is reduced in platelet concentrates ex vivo but appears restored following transfusion. Transfusion 2021; 61:3420-3431. [PMID: 34611925 DOI: 10.1111/trf.16695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/11/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND The procoagulant profile of platelet concentrates (PCs) following transfusion has been difficult to evaluate due to lack of specific markers. This study aimed to characterize procoagulant platelets in PCs and the effect of transfusion. STUDY DESIGN AND METHODS Buffy coat-derived PCs from 12 donors were pooled, split, then stored conventionally, cold (2-6°C) or cryopreserved (-80°C). Procoagulant platelet profiles were assessed by flow cytometry (GSAO+ /P-selectin+ ), lactadherin-binding, and calibrated automated thrombogram, during storage, unstimulated, or after thrombin and collagen stimulation and compared with blood from healthy volunteers. Platelet activation (P-selectin) and procoagulant platelet formation potential were measured (flow cytometry) in patients receiving clinically indicated conventional PC transfusion. RESULTS Independent of significant increases with storage, procoagulant platelet proportions with and without agonist stimulation were significantly blunted in conventionally stored PCs (stimulated day 5 conventional PC 4.2 ± 1.3%, healthy volunteer blood 11.1 ± 2.9%; p < .0001). Cryopreserved PCs contained the highest proportion of procoagulant platelets (unstimulated: cryopreserved 25.6 ± 1.8% vs. day 5 conventional 0.5 ± 0.1% vs. day 14 cold-stored 5.8 ± 1.0%, p < .0001), but demonstrated minimal increase with agonist. Transfusion of PCs was associated with an increase in procoagulant platelets (2.2 ± 1.4% vs. 0.6 ± 0.2%; p = .004) and reversal of the blunted agonist response (15.8 ± 5.9% vs. 4.0 ± 1.6%; p < .0001). Procoagulant responses post-transfusion were significantly higher than healthy controls, suggesting a priming effect. The P-selectin agonist response was not restored upon transfusion (79.4 ± 13.9% vs. 82.0 ± 2.5%). CONCLUSION Storage blunts the procoagulant platelet response to agonist stimulation in PCs. Despite this, conventionally stored PCs have high procoagulant potential following transfusion, with a discordant, persistent reduction in P-selectin response.
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Affiliation(s)
- Ibrahim Tohidi-Esfahani
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Haematology Department, Concord Repatriation General Hospital, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shereen Tan
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Chuen Wen Tan
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Haematology Department, Singapore General Hospital, Singapore, Singapore
| | - Lacey Johnson
- Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Denese C Marks
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Research and Development, Australian Red Cross Lifeblood, Sydney, Australia
| | - Vivien M Chen
- ANZAC Research Institute, University of Sydney, Sydney, Australia.,Haematology Department, Concord Repatriation General Hospital, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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10
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Pandey S, Belanger GA, Rajbhandary S, Cohn CS, Benjamin RJ, Bracey AW, Katz LM, Menitove JE, Mintz PD, Gammon RR. A survey of US hospitals on platelet inventory management, transfusion practice, and platelet availability. Transfusion 2021; 61:2611-2620. [PMID: 34287930 DOI: 10.1111/trf.16561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND A survey of US hospitals was conducted to increase our understanding of the current state of platelet (PLT) practice and supply. The survey captures information on transfusion practice and inventory management, including stock levels, outdate rates, ability to return or transfer PLTs, and low dose PLTs. Notably, the survey also elucidates PLT availability challenges and impact to patient care. STUDY DESIGN AND METHODS A 27 question online survey was distributed directly to over 995 US hospitals and indirectly through blood centers to many more between September 27 and October 25, 2019. Descriptive statistics were used for respondent characteristics. Bivariate analysis was performed and correlation coefficients, chi square tests, and p values determined statistical significance of relationships between variables. RESULTS Four hundred and eighty-one hospitals completed the survey of which 21.6%, 53.2%, and 25.2% were characterized as small, medium, and large hospitals, respectively. Some key observations from this survey include: (1) there is an opportunity for greater adherence to evidence-based guidelines; (2) higher outdate rates occur in hospitals stocking less than five PLTs and the ability to return or transfer PLTs lowers outdates; (3) use of low dose apheresis PLTs varies; and (4) decreased PLT availability is commonly reported, especially in hospitals with high usage, and can lead to delays in transfusions or surgeries. CONCLUSION This survey represents a comprehensive national assessment of inventory management practices and PLT availability challenges in US hospitals. Findings from this survey can be used to guide further research, help shape future guidance for industry, and assist with policy decisions.
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Affiliation(s)
- Suchitra Pandey
- Department of Pathology, Stanford University, Palo Alto, California, USA.,Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | - Geoffrey A Belanger
- Medical Services, Operations Excellence, Stanford Blood Center, Stanford Health Care, Palo Alto, California, USA
| | | | - Claudia S Cohn
- Department of Research, AABB, Bethesda, Maryland, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard J Benjamin
- Clinical Research and Medical Affairs, Cerus Corporation, Concord, California, USA
| | - Arthur W Bracey
- Department of Pathology, Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Louis M Katz
- Medical Affairs, ImpactLife (formerly Mississippi Valley Regional Blood Center), Davenport, Iowa, USA
| | - Jay E Menitove
- Department of Pathology and Lab Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Paul D Mintz
- Medical Affairs, Verax Biomedical, Inc, Marlborough, Massachusetts, USA
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11
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Matsui R, Hagino T, Tsuno NH, Ohtani H, Azuma F, Matsuhashi M, Saito M, Kobayashi M, Saga R, Hidai H, Tsutsumi H, Akiyama H, Motomura S. Does time of CCI measurement affect the evaluation of platelet transfusion effectiveness? Transfus Apher Sci 2021; 60:103123. [PMID: 33757699 DOI: 10.1016/j.transci.2021.103123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/05/2021] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
The measurement of corrected count increment at 1-h post-transfusion (CCI-1 h) of platelet concentrate (PC) transfusion is recommended, but in the revised Japanese Guideline (2017) it was changed to "after 10-min to 1-h", following the revision of the guidelines from Western countries. Here, we aimed to investigate on the feasibility to apply the CCI measured at 10-min or 30-min post-transfusion as the surrogate of CCI-1 h. Peripheral blood was collected at 10-min, 30-min and 1-h post-transfusion of PC and the effectiveness of the transfusion was analyzed based on the CCI. In the period from December 2017 to February 2020, 8 patients, who received multiple PC transfusion (total 208) at our institution, were analyzed. We performed the univariate analyses to examine the relationship between CCI value and the categorical variables, p-value <0.1 was obtained for gender (p = 2.91 × 10-19), fever after transfusion (p = 0.0163). The qualitative variables, namely measurement time (p = 0.0553), also showed p-value <0.1. Using these factors as covariates in the mixed effect model, we found that the measurement time (p = 0.0007) had a significant effect on the CCI value when looking at fixed effects. Although there is a tendency for decreased CCI values with time progression, the slope of the change in the mixed model was -0.00307, indicating that the CCI difference among the 3 measurements was small. Here we provide evidence that CCI measured at 10-min and 30-min post-transfusion give results comparable to those measured at 1-h post-transfusion, under the Japanese practice of platelet transfusion, which relies on 100 % single-donor apheresis PC, and ABO-identical whenever possible.
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Affiliation(s)
- Reina Matsui
- Department of Laboratory Medicine, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Takeshi Hagino
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan.
| | | | - Hideo Ohtani
- Department of Laboratory Medicine, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Fumihiro Azuma
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | - Mika Matsuhashi
- Japanese Red Cross Kanto-Koshinetsu Block Blood Center, Tokyo, Japan
| | - Makoto Saito
- Clinical Research Support Center, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Maya Kobayashi
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Reina Saga
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Hiroko Hidai
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Hisashi Tsutsumi
- Department of Laboratory Medicine, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Hideki Akiyama
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
| | - Sayuri Motomura
- Department of Hematology, Tama-Hokubu Medical Center, Tokyo Metropolitan Health and Medical Treatment Corporation, Tokyo, Japan
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12
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Saris A, Steuten J, Schrijver DP, van Schijndel G, Zwaginga JJ, van Ham SM, ten Brinke A. Inhibition of Dendritic Cell Activation and Modulation of T Cell Polarization by the Platelet Secretome. Front Immunol 2021; 12:631285. [PMID: 33737933 PMCID: PMC7961920 DOI: 10.3389/fimmu.2021.631285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
Platelet transfusions are a frequently administered therapy for especially hemato-oncological patients with thrombocytopenia. Next to their primary function in hemostasis, currently there is increased attention for the capacity of platelets to affect the function of various cells of the immune system. Here, we investigate the capacity of platelets to immuno-modulate monocyte-derived dendritic cells (moDC) as well as primary dendritic cells and effects on subsequent T cell responses. Platelets significantly inhibited pro-inflammatory (IL-12, IL-6, TNFα) and increased anti-inflammatory (IL-10) cytokine production of moDCs primed with toll-like receptor (TLR)-dependent and TLR-independent stimuli. Transwell assays and ultracentrifugation revealed that a soluble factor secreted by platelets, but not microvesicles, inhibited DC activation. Interestingly, platelet-derived soluble mediators also inhibited cytokine production by human ex vivo stimulated myeloid CD1c+ conventional DC2. Moreover, platelets and platelet-derived soluble mediators inhibited T cell priming and T helper differentiation toward an IFNγ+ Th1 phenotype by moDCs. Overall, these results show that platelets are able to inhibit the pro-inflammatory properties of DCs, and may even induce an anti-inflammatory DC phenotype, with decreased T cell priming capacity by the DC. The results of this study provide more insight in the potential role of platelets in immune modulation, especially in the context of platelet transfusions.
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Affiliation(s)
- Anno Saris
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Infectious Disease, Leiden University Medical Center, Leiden, Netherlands
| | - Juulke Steuten
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - David P. Schrijver
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Gijs van Schijndel
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, Netherlands
- Department of Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
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13
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Cornelissen LL, Caram-Deelder C, Meier RT, Zwaginga JJ, Evers D. Platelet transfusion and tranexamic acid to prevent bleeding in outpatients with a hematological disease: A Dutch nationwide survey. Eur J Haematol 2020; 106:362-370. [PMID: 33226659 PMCID: PMC7898625 DOI: 10.1111/ejh.13555] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES There is scarce evidence about the effectiveness of anti-bleeding measures in hematological outpatients experiencing persistent severe thrombocytopenia. We aim to describe clinical practice and clinicians' considerations on the administration of prophylactic platelet transfusions and tranexamic acid (TXA) to outpatients with acute leukemia, myelodysplastic syndrome (MDS), or aplastic anemia (AA) in the Netherlands. METHODS We conducted an online survey among members of the Dutch Society for Hematology. RESULTS The survey was filled out by 73 respondents. Prophylactic platelet transfusions are widely used in acute leukemia and MDS outpatients receiving disease-modifying treatments (87%-98% of respondents). TXA is predominantly prescribed in case of bleeding (tendency) (71%-88% of respondents). Conditions potentially increasing bleeding risks highly variably influence clinicians' decision making on anti-bleeding regimens, which includes a wide range in adhered platelet thresholds. CONCLUSION Considering that both the contribution of prophylactic platelet transfusions as well as TXA to limiting bleeding is insufficiently evidence-based, there is an urgent need for trials on optimal anti-bleeding strategies in this outpatient population, which should encompass efficacy, logistic, financial, and quality-of-life aspects.
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Affiliation(s)
- Loes L Cornelissen
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Romy T Meier
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
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14
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Cornelissen LL, Kreuger AL, Caram-Deelder C, Middelburg RA, Kerkhoffs JLH, von dem Borne PA, Beckers EAM, de Vooght KMK, Kuball J, Zwaginga JJ, van der Bom JG. Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with acute leukemia - a nested case-control study. Ann Hematol 2020; 100:261-271. [PMID: 33067700 PMCID: PMC7782440 DOI: 10.1007/s00277-020-04298-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023]
Abstract
We designed a study to describe the incidence of intracranial hemorrhage according to severity and duration of thrombocytopenia and to quantify the associations of platelet transfusions with intracranial hemorrhage in patients with acute leukemia. In this case-control study nested in a cohort of 859 leukemia patients, cases (n = 17) were patients diagnosed with intracranial hemorrhage who were matched with control patients (n = 55). We documented platelet counts and transfusions for seven days before the intracranial hemorrhage in cases and in a “matched” week for control patients. Three measures of platelet count exposure were assessed in four potentially important time periods before hemorrhage. Among these leukemia patients, we observed the cumulative incidence of intracranial hemorrhage of 3.5%. Low platelet counts were, especially in the three to seven days preceding intracranial hemorrhage, associated with the incidence of intracranial hemorrhage, although with wide confidence intervals. Platelet transfusions during the week preceding the hemorrhage were associated with higher incidences of intracranial hemorrhage; rate ratios (95% confidence interval) for one or two platelet transfusions and for more than two transfusions compared with none were 4.04 (0.73 to 22.27) and 8.91 (1.53 to 51.73) respectively. Thus, among acute leukemia patients, the risk of intracranial hemorrhage was higher among patients with low platelet counts and after receiving more platelet transfusions. Especially, the latter is likely due to clinical factors leading to increased transfusion needs.
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Affiliation(s)
- Loes L Cornelissen
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aukje L Kreuger
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger A Middelburg
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean Louis H Kerkhoffs
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Hematology, Haga Teaching Hospital, Den Haag, The Netherlands
| | | | - Erik A M Beckers
- Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Zwaginga
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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15
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Flint AWJ, Bailey M, Reid CM, Smith JA, Tran L, Wood EM, McQuilten ZK, Reade MC. Preoperative identification of cardiac surgery patients at risk of receiving a platelet transfusion: The Australian Cardiac Surgery Platelet Transfusion (
ACSePT
) risk prediction tool. Transfusion 2020; 60:2272-2283. [DOI: 10.1111/trf.15990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Andrew W. J. Flint
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
- The Australian and New Zealand Intensive Care Research Centre (ANZIC‐RC), School of Public Health and Preventive Medicine Monash University Melbourne Australia
- Royal Australian Navy Australia
- Intensive Care Unit Royal Darwin Hospital Tiwi Northern Territory Australia
| | - Michael Bailey
- The Australian and New Zealand Intensive Care Research Centre (ANZIC‐RC), School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
- School of Public Health Curtin University Perth Australia
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Julian A. Smith
- Monash Health Clayton Victoria Australia
- Department of Surgery (School of Clinical Sciences at Monash Health) Monash University and Department of Cardiothoracic Surgery, Monash Health Clayton Victoria Australia
- Chairman, Research Committee Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS); Cardiac Surgery Database
| | - Lavinia Tran
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
- Centre of Cardiovascular Research and Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Erica M. Wood
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
- Monash Health Clayton Victoria Australia
| | - Zoe K. McQuilten
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
- The Australian and New Zealand Intensive Care Research Centre (ANZIC‐RC), School of Public Health and Preventive Medicine Monash University Melbourne Australia
- Monash Health Clayton Victoria Australia
| | - Michael C. Reade
- The Australian and New Zealand Intensive Care Research Centre (ANZIC‐RC), School of Public Health and Preventive Medicine Monash University Melbourne Australia
- Joint Health Command Australian Defence Force Canberra Australia
- Faculty of Medicine University of Queensland Brisbane Australia
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16
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Valsami S, Pouliakis A, Gavalaki M, Argyrou A, Triantafillou E, Arvanitopoulou E, Girtovitis F, Voulgaridou V, Megalou A, Chronopoulou P, Papachronis A, Sakellarakis G, Zervou E, Batsi C, Fountouli K, Athanasopoulos A, Kyriakou E, Cheropoulou A, Livada A, Lebessopoulos K, Papakonstantinou M, Gafou A, Katopi D, Martinis G, Dendrinou I, Katharopoulou H, Politou M, Papadopoulou M, Papadopoulou P, Manaka E, Paneta K, Alepi C, Damaskos C, Garmpis N, Stamoulis K, Grouzi E. Platelets transfusion in Greece: Where, when, why? A national survey. Asian J Transfus Sci 2020; 14:158-166. [PMID: 33767543 PMCID: PMC7983137 DOI: 10.4103/ajts.ajts_72_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Platelet transfusion is among the most useful therapeutic tools in modern clinical settings which mean that ensuring an adequate supply is of paramount importance. AIM The aim of our study was to record the use and wastage of platelet concentrates (PCs) in Greece, so as to come up with evidence-based interventions. METHODS The study was conducted during May and June 2015. We evaluated the use of random-donor platelets (RDPs) and single-donor apheresis platelets (SDPs). We analyzed such parameters as hospital department and diagnosis, indication for transfusion, PCs' age at the time of transfusion, and wastage rate. RESULTS We used data from 21 hospitals across the country. A total of 12,061 RDPs and 1189 SDPs were transfused, with an average of 4.84 (±2.72) and 1.12 (±2.73) units per episode, respectively. Most patients had been admitted to the internal medicine and hematology departments. The transfusions were mostly given prophylactically, usually in cases of acute leukemia, and mostly on the day before expiration. Wastage rate was 16.75% for RPDs and 2.70% for SDPs, primarily because of the expiration of the use-by date. CONCLUSIONS This is the first national survey regarding platelet transfusion in Greece. Since most patients were admitted in internal medicine and hematology departments, we recommend that the staff of the abovementioned departments should undergo training on contemporary transfusion guidelines. Platelet discard rate could further be lowered through the centralization of inventory management along with the extension of the lifetime of PCs by means of emerging technologies.
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Affiliation(s)
- Serena Valsami
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Patras, Greece
| | - Maria Gavalaki
- Department of Blood Transfusion, Laiko General Hospital, Patras, Greece
| | - Aspasia Argyrou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | | | | | - Fotios Girtovitis
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Virginia Voulgaridou
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Megalou
- Department of Blood Transfusion, Evangelismos Hospital, Patras, Greece
| | | | | | | | - Eleftheria Zervou
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Christina Batsi
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Kalliopi Fountouli
- Department of Blood Transfusion, University Hospital of Heraklion, Heraklion, Greece
| | | | - Elias Kyriakou
- Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, National and Kapodistrian Athens, Patras, Greece
| | | | - Anastasia Livada
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
| | | | | | - Anthi Gafou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | - Despina Katopi
- Department of Blood Transfusion, General Hospital Alexandra, Patras, Greece
| | - George Martinis
- Department of Blood Transfusion, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioanna Dendrinou
- Department of Blood Transfusion, General Hospital Nea Ionia “Agia Olga”, Patras, Greece
| | - Hrysanthi Katharopoulou
- Department of Blood Transfusion, “Hatzikosta” General Hospital of Ioannina, Ioannina, Greece
| | - Marianna Politou
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | | | | | - Ekaterini Manaka
- Department of Blood Transfusion, General Hospital of Messologgi, Messologgi, Greece
| | - Konstantina Paneta
- Department of Blood Transfusion, General Hospital of Pirgos, Pirgos, Greece
| | - Chrissoula Alepi
- Department of Blood Transfusion, General Hospital “Tzaneio” of Piraeus, Patras, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | | | - Elisavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
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17
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Gottschall J, Wu Y, Triulzi D, Kleinman S, Strauss R, Zimrin AB, McClure C, Tan S, Bialkowski W, Murphy E, Ness P. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion 2019; 60:46-53. [PMID: 31850522 DOI: 10.1111/trf.15637] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the Recipient and Donor Epidemiology Study-III (REDS-III) recipient and donor databases, we performed a retrospective analysis of platelet use in 12 US hospitals that were participants in REDS-III. STUDY DESIGN AND METHODS Data were electronically extracted from participating transfusion service and blood center computer systems and from medical records of the 12 REDS-III hospitals. All platelet transfusions from 2013 to 2016 given to patients aged 18 years and older were included in the analysis. RESULTS There were 28,843 inpatients and 2987 outpatients who were transfused with 163,719 platelet products (103,371 apheresis, 60,348 whole blood derived); 93.5% of platelets were leukoreduced and 72.5% were irradiated. Forty-six percent were transfused to patients with an International Classification of Diseases, 9th/10th Revision (ICD-9/10) diagnosis of leukemia, myelodysplastic syndrome (MDS), or lymphoma. The general ward and the intensive care unit (ICU) were the most common issue locations. Only 54% of platelet transfusions were ABO identical; and 60.6% of platelet transfusions given to Rh-negative patients were Rh positive. The most common pretransfusion platelet count range for inpatients was 20,000 to 50,000/μL, for outpatients it was 10,000 to 20,000/μL. Among ICU patients, 35% of platelet transfusion episodes had a platelet count of greater than 50,000/μL; this was only 8% for general ward and 2% for outpatients. The median posttransfusion increment, not corrected for platelet dose and/or patient size, ranged from 12,000 to 20,000/μL for inpatients, and from 17,000 to 27,000/μL for outpatients. CONCLUSIONS These data from one of the largest reviews of platelet transfusion practice to date provide guidance for where to focus future clinical research studies and platelet blood management programs.
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Affiliation(s)
| | - YanYun Wu
- Bloodworks Northwest, Seattle, Washington
| | | | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald Strauss
- LifeSource/Institute for Transfusion Medicine, Chicago, Illinois
| | | | | | - Sylvia Tan
- RTI International, Raleigh, North Carolina
| | | | - Edward Murphy
- University of California San Francisco, San Francisco, California
| | - Paul Ness
- Johns Hopkins University, Baltimore, Maryland
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18
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Jóhannsson F, Árnason NÁ, Landrö R, Guðmundsson S, Sigurjonsson ÓE, Rolfsson Ó. Metabolomics study of platelet concentrates photochemically treated with amotosalen and UVA light for pathogen inactivation. Transfusion 2019; 60:367-377. [PMID: 31802514 DOI: 10.1111/trf.15610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The risk of bacterial contamination and the deterioration of platelet (PLT) quality limit the shelf-life of platelet concentrates (PCs). The INTERCEPT pathogen inactivation system reduces the risk of pathogen transmission by inhibiting nucleic acid replication using a combination of a photo-reactive compound and UVA illumination. The goal of this study was to investigate the effects the INTERCEPT system has on the PLT metabolome and metabolic activity. STUDY DESIGN AND METHODS Paired units of buffy coat-derived PCs were generated using a pool and split strategy (n = 8). The paired PCs were either treated with the INTERCEPT system or left untreated. Samples were collected on Days 1, 2, 4, and 7 of storage. Ultra-performance chromatography coupled with time-of-flight mass spectrometry was used to analyze the extra- and intracellular metabolomes. Constraint-based metabolic modeling was then used to predict the metabolic activity of the stored PLTs. RESULTS A relatively large number of metabolites in the extracellular environment were depleted during the processing steps of the INTERCEPT system, in particular, metabolites with hydrophobic functional groups, including acylcarnitines and lysophosphatidylcholines. In the intracellular environment, alterations in glucose and glycerophospholipid metabolism and decreased levels of 2-hydroxyglutarate were observed following the INTERCEPT treatment. Untargeted metabolomics analysis revealed residual amotosalen dimers present in the treated PCs. Systems-level analysis of PLT metabolism indicated that the INTERCEPT system does not have a significant impact on the PLT energy metabolism and nutrient utilization. CONCLUSIONS The INTERCEPT system significantly alters the metabolome of the stored PCs without significantly influencing PLT energy metabolism.
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Affiliation(s)
- Freyr Jóhannsson
- Center for Systems Biology, University of Iceland, Sturlugata 8, Reykjavik, Iceland.,Medical Department, University of Iceland, Sturlugata 8, Reykjavik, Iceland
| | - Níels Á Árnason
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Ragna Landrö
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Sveinn Guðmundsson
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland
| | - Ólafur E Sigurjonsson
- The Blood Bank, Landspitali-University Hospital, Snorrabraut 60, Reykjavik, Iceland.,School of Science and Engineering, Reykjavik University, Menntavegur 1, Reykjavik, Iceland
| | - Óttar Rolfsson
- Center for Systems Biology, University of Iceland, Sturlugata 8, Reykjavik, Iceland.,Medical Department, University of Iceland, Sturlugata 8, Reykjavik, Iceland
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19
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Arnason NA, Johannson F, Landrö R, Hardarsson B, Irsch J, Gudmundsson S, Rolfsson O, Sigurjonsson OE. Pathogen inactivation with amotosalen plus UVA illumination minimally impacts microRNA expression in platelets during storage under standard blood banking conditions. Transfusion 2019; 59:3727-3735. [PMID: 31674051 DOI: 10.1111/trf.15575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/15/2019] [Accepted: 10/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND To reduce the risk of transfusion transmission infection, nucleic acid targeted methods have been developed to inactivate pathogens in PCs. miRNAs have been shown to play an important role in platelet function, and changes in the abundance of specific miRNAs during storage have been observed, as have perturbation effects related to pathogen inactivation (PI) methods. The aim of this work was to investigate the effects of PI on selected miRNAs during storage. STUDY DESIGN AND METHODS Using a pool and split strategy, 3 identical buffy coat PC units were generated from a pool of 24 whole blood donors. Each unit received a different treatment: 1) Untreated platelet control in platelet additive solution (C-PAS); 2) Amotosalen-UVA-treated platelets in PAS (PI-PAS); and 3) untreated platelets in donor plasma (U-PL). PCs were stored for 7 days under standard blood banking conditions. Standard platelet quality control (QC) parameters and 25 selected miRNAs were analyzed. RESULTS During the 7-day storage period, differences were found in several QC parameters relating to PI treatment and storage in plasma, but overall the three treatments were comparable. Out of 25 miRNA tested changes in regulation of 5 miRNA in PI-PAS and 3 miRNA U-PL where detected compared to C-PAS. A statistically significant difference was observed in down regulations miR-96-5p on Days 2 and 4, 61.9% and 61.8%, respectively, in the PI-PAS treatment. CONCLUSION Amotosalen-UVA treatment does not significantly alter the miRNA profile of platelet concentrates generated and stored using standard blood banking conditions.
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Affiliation(s)
- Niels Arni Arnason
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Freyr Johannson
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ragna Landrö
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Björn Hardarsson
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Sveinn Gudmundsson
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ottar Rolfsson
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Olafur E Sigurjonsson
- The Blood Bank, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,School of Science and Engineering, Reykjavik University, Reykjavik, Iceland
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20
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Scorer TG, Reddoch-Cardenas KM, Thomas KA, Cap AP, Spinella PC. Therapeutic Utility of Cold-Stored Platelets or Cold-Stored Whole Blood for the Bleeding Hematology-Oncology Patient. Hematol Oncol Clin North Am 2019; 33:873-885. [PMID: 31466610 DOI: 10.1016/j.hoc.2019.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bleeding related to thrombocytopenia is common in hematology-oncology patients. Platelets stored at room temperature (RTPs) are the current standard of care. Platelets stored in the cold (CSPs) have enhanced hemostatic function relative to RTPs. CSPs were reported to reduce bleeding in hematology-oncology patients. Recent studies have confirmed the enhanced hemostatic properties of CSPs. CSPs may be the better therapeutic option for this population. CSPs may also offer a preferable immune profile, reduced thrombotic risk, and reduced transfusion-transmitted infection risk. The logistical advantages of CSPs would improve outcomes for many patients who currently cannot access platelet transfusions.
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Affiliation(s)
- Thomas G Scorer
- School of Cellular and Molecular Medicine, University of Bristol, Bristol Royal Infirmary, Research Floor 7, Queens Building, Bristol, BS2 8HW, UK; Centre of Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK.
| | - Kristin M Reddoch-Cardenas
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, BLDG 3610, JBSA-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Kimberly A Thomas
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Andrew P Cap
- Coagulation and Blood Research, U.S. Army Institute of Surgical Research, 3698 Chambers Pass, BLDG 3610, JBSA-Fort Sam Houston, San Antonio, TX 78234, USA
| | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
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21
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Secular trends in the distribution of allogeneic blood components in Taiwan. J Formos Med Assoc 2019; 118:1369-1374. [PMID: 30928185 DOI: 10.1016/j.jfma.2019.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/20/2022] Open
Abstract
Recent blood distribution profiles for transfusions in Taiwan have not been comprehensively documented. This study aimed to analyze trends in red blood cell (RBC), platelet, and plasma distribution rates, and compares these profiles with those in other countries. The distribution rates of RBC, platelets, and plasma in Taiwan during 2015 were 47.6, 11.1, and 26.8 units per 1000 population, respectively. At least 1.5 and 2.5-fold higher platelet and plasma distribution rates were observed than other selected countries. During 2007-2015, there was no significant change in RBC distribution. However, we observed a significant increase of 0.20 (95% CI: 0.11-0.30) adult doses of platelets, and a significant decrease of 1.69 (95% CI: 1.45-1.93) units of plasma per 1000 population per annum. Seven other countries showed a general significant decreasing trend of RBC distributions. Higher blood distribution rates were observed in Taiwan. Therefore, the adoption of patient blood management is essential.
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22
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Estcourt LJ, Malouf R, Hopewell S, Trivella M, Doree C, Stanworth SJ, Murphy MF. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database Syst Rev 2017; 7:CD009072. [PMID: 28756627 PMCID: PMC5558872 DOI: 10.1002/14651858.cd009072.pub3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Platelet transfusions are used to prevent and treat bleeding in people who are thrombocytopenic. Despite improvements in donor screening and laboratory testing, a small risk of viral, bacterial, or protozoal contamination of platelets remains. There is also an ongoing risk from newly emerging blood transfusion-transmitted infections for which laboratory tests may not be available at the time of initial outbreak.One solution to reduce the risk of blood transfusion-transmitted infections from platelet transfusion is photochemical pathogen reduction, in which pathogens are either inactivated or significantly depleted in number, thereby reducing the chance of transmission. This process might offer additional benefits, including platelet shelf-life extension, and negate the requirement for gamma-irradiation of platelets. Although current pathogen-reduction technologies have been proven to reduce pathogen load in platelet concentrates, a number of published clinical studies have raised concerns about the effectiveness of pathogen-reduced platelets for post-transfusion platelet count recovery and the prevention of bleeding when compared with standard platelets.This is an update of a Cochrane review first published in 2013. OBJECTIVES To assess the effectiveness of pathogen-reduced platelets for the prevention of bleeding in people of any age requiring platelet transfusions. SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 24 October 2016. SELECTION CRITERIA We included RCTs comparing the transfusion of pathogen-reduced platelets with standard platelets, or comparing different types of pathogen-reduced platelets. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS We identified five new trials in this update of the review. A total of 15 trials were eligible for inclusion in this review, 12 completed trials (2075 participants) and three ongoing trials. Ten of the 12 completed trials were included in the original review. We did not identify any RCTs comparing the transfusion of one type of pathogen-reduced platelets with another.Nine trials compared Intercept® pathogen-reduced platelets to standard platelets, two trials compared Mirasol® pathogen-reduced platelets to standard platelets; and one trial compared both pathogen-reduced platelets types to standard platelets. Three RCTs were randomised cross-over trials, and nine were parallel-group trials. Of the 2075 participants enrolled in the trials, 1981 participants received at least one platelet transfusion (1662 participants in Intercept® platelet trials and 319 in Mirasol® platelet trials).One trial included children requiring cardiac surgery (16 participants) or adults requiring a liver transplant (28 participants). All of the other participants were thrombocytopenic individuals who had a haematological or oncological diagnosis. Eight trials included only adults.Four of the included studies were at low risk of bias in every domain, while the remaining eight included studies had some threats to validity.Overall, the quality of the evidence was low to high across different outcomes according to GRADE methodology.We are very uncertain as to whether pathogen-reduced platelets increase the risk of any bleeding (World Health Organization (WHO) Grade 1 to 4) (5 trials, 1085 participants; fixed-effect risk ratio (RR) 1.09, 95% confidence interval (CI) 1.02 to 1.15; I2 = 59%, random-effect RR 1.14, 95% CI 0.93 to 1.38; I2 = 59%; low-quality evidence).There was no evidence of a difference between pathogen-reduced platelets and standard platelets in the incidence of clinically significant bleeding complications (WHO Grade 2 or higher) (5 trials, 1392 participants; RR 1.10, 95% CI 0.97 to 1.25; I2 = 0%; moderate-quality evidence), and there is probably no difference in the risk of developing severe bleeding (WHO Grade 3 or higher) (6 trials, 1495 participants; RR 1.24, 95% CI 0.76 to 2.02; I2 = 32%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of all-cause mortality at 4 to 12 weeks (6 trials, 1509 participants; RR 0.81, 95% CI 0.50 to 1.29; I2 = 26%; moderate-quality evidence).There is probably no difference between pathogen-reduced platelets and standard platelets in the incidence of serious adverse events (7 trials, 1340 participants; RR 1.09, 95% CI 0.88 to 1.35; I2 = 0%; moderate-quality evidence). However, no bacterial transfusion-transmitted infections occurred in the six trials that reported this outcome.Participants who received pathogen-reduced platelet transfusions had an increased risk of developing platelet refractoriness (7 trials, 1525 participants; RR 2.94, 95% CI 2.08 to 4.16; I2 = 0%; high-quality evidence), though the definition of platelet refractoriness differed between trials.Participants who received pathogen-reduced platelet transfusions required more platelet transfusions (6 trials, 1509 participants; mean difference (MD) 1.23, 95% CI 0.86 to 1.61; I2 = 27%; high-quality evidence), and there was probably a shorter time interval between transfusions (6 trials, 1489 participants; MD -0.42, 95% CI -0.53 to -0.32; I2 = 29%; moderate-quality evidence). Participants who received pathogen-reduced platelet transfusions had a lower 24-hour corrected-count increment (7 trials, 1681 participants; MD -3.02, 95% CI -3.57 to -2.48; I2 = 15%; high-quality evidence).None of the studies reported quality of life.We did not evaluate any economic outcomes.There was evidence of subgroup differences in multiple transfusion trials between the two pathogen-reduced platelet technologies assessed in this review (Intercept® and Mirasol®) for all-cause mortality and the interval between platelet transfusions (favouring Intercept®). AUTHORS' CONCLUSIONS Findings from this review were based on 12 trials, and of the 1981 participants who received a platelet transfusion only 44 did not have a haematological or oncological diagnosis.In people with haematological or oncological disorders who are thrombocytopenic due to their disease or its treatment, we found high-quality evidence that pathogen-reduced platelet transfusions increase the risk of platelet refractoriness and the platelet transfusion requirement. We found moderate-quality evidence that pathogen-reduced platelet transfusions do not affect all-cause mortality, the risk of clinically significant or severe bleeding, or the risk of a serious adverse event. There was insufficient evidence for people with other diagnoses.All three ongoing trials are in adults (planned recruitment 1375 participants) with a haematological or oncological diagnosis.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Reem Malouf
- University of OxfordNational Perinatal Epidemiology Unit (NPEU)Old Road CampusOxfordUKOX3 7LF
| | - Sally Hopewell
- University of OxfordOxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesWindmill RoadOxfordUKOX3 7LD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineBotnar Research CentreWindmill RoadOxfordUKOX3 7LD
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Michael F Murphy
- Oxford University Hospitals NHS Foundation Trust and University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
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23
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Chen J, Losos M, Yang S, Li J, Wu H, Cataland S. Increased complement activation during platelet storage. Transfusion 2017; 57:2182-2188. [DOI: 10.1111/trf.14215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/29/2017] [Accepted: 05/07/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Jian Chen
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Michael Losos
- Department of Pathology and Immunology; Baylor College of Medicine; Houston Texas
| | - Shangbin Yang
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Junan Li
- College of Pharmacy; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Haifeng Wu
- Department of Pathology; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Spero Cataland
- Department of Internal Medicine, Division of Hematology; The Ohio State University Wexner Medical Center; Columbus Ohio
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24
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Orsini S, Noris P, Bury L, Heller PG, Santoro C, Kadir RA, Butta NC, Falcinelli E, Cid AR, Fabris F, Fouassier M, Miyazaki K, Lozano ML, Zúñiga P, Flaujac C, Podda GM, Bermejo N, Favier R, Henskens Y, De Maistre E, De Candia E, Mumford AD, Ozdemir GN, Eker I, Nurden P, Bayart S, Lambert MP, Bussel J, Zieger B, Tosetto A, Melazzini F, Glembotsky AC, Pecci A, Cattaneo M, Schlegel N, Gresele P. Bleeding risk of surgery and its prevention in patients with inherited platelet disorders. Haematologica 2017; 102:1192-1203. [PMID: 28385783 PMCID: PMC5566025 DOI: 10.3324/haematol.2016.160754] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 04/04/2017] [Indexed: 11/16/2022] Open
Abstract
Excessive bleeding at surgery is a feared complication in patients with inherited platelet disorders. However, very few studies have evaluated the frequency of surgical bleeding in these hemorrhagic disorders. We performed a worldwide, multicentric, retrospective study to assess the bleeding complications of surgery, the preventive and therapeutic approaches adopted, and their efficacy in patients with inherited platelet disorders: the Surgery in Platelet disorders And Therapeutic Approach (SPATA) study. We rated the outcome of 829 surgical procedures carried out in 423 patients with well-defined forms of inherited platelet disorders: 238 inherited platelet function disorders and 185 inherited platelet number disorders. Frequency of surgical bleeding was high in patients with inherited platelet disorders (19.7%), with a significantly higher bleeding incidence in inherited platelet function disorders (24.8%) than in inherited platelet number disorders (13.4%). The frequency of bleeding varied according to the type of inherited platelet disorder, with biallelic Bernard Soulier syndrome having the highest occurrence (44.4%). Frequency of bleeding was predicted by a pre-operative World Health Organization bleeding score of 2 or higher. Some types of surgery were associated with a higher bleeding incidence, like cardiovascular and urological surgery. The use of pre-operative pro-hemostatic treatments was associated with a lower bleeding frequency in patients with inherited platelet function disorders but not in inherited platelet number disorders. Desmopressin, alone or with antifibrinolytic agents, was the preventive treatment associated with the lowest bleedings. Platelet transfusions were used more frequently in patients at higher bleeding risk. Surgical bleeding risk in inherited platelet disorders is substantial, especially in inherited platelet function disorders, and bleeding history, type of disorder, type of surgery and female sex are associated with higher bleeding frequency. Prophylactic pre-operative pro-hemostatic treatments appear to be required and are associated with a lower bleeding incidence.
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Affiliation(s)
- Sara Orsini
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Loredana Bury
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Paula G Heller
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CONICET, Argentina
| | | | - Rezan A Kadir
- Haemophilia Centre and Haemostasis Unit, Royal Free Hospital, London, UK
| | - Nora C Butta
- Unidad de Hematología, Hospital Universitario La Paz-IDIPaz, Madrid, Spain
| | - Emanuela Falcinelli
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Ana Rosa Cid
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
| | - Fabrizio Fabris
- Clinica Medica 1 - Medicina Interna CLOPD, Dipartimento Assistenziale Integrato di Medicina, Azienda-Ospedale Università di Padova and Dipartimento di Medicina, Università di Padova, Italy
| | | | - Koji Miyazaki
- Department of Hematology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Maria Luisa Lozano
- Servicio de Hematología y Oncología Médica, Hospital Universitario Morales Meseguery Centro Regional de Hemodonación, IMIB-Arrixaca, Universidad de Murcia, Murcia 30003 and Grupo de Investigación CB15/00055 del Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Pamela Zúñiga
- Department of Hematology-Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claire Flaujac
- Service d'Hématologie Biologique Cochin Hospital, Paris, France
| | - Gian Marco Podda
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Nuria Bermejo
- Department of Hematology, Hospital San Pedro de Alcántara, Cáceres, Spain
| | - Remi Favier
- Assistance Publique-Hôpitaux de Paris, Armand Trousseau Children's Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France
| | - Yvonne Henskens
- Hematological Laboratory, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Emmanuel De Maistre
- Department of Biology and Haematology, Centre Hospitalier Universitaire Dijon, France
| | - Erica De Candia
- Hemostasis and Thrombosis Unit, Institute of Internal Medicine, Policlinico Agostino Gemelli-Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Gul Nihal Ozdemir
- Cerrahpasa Medical Faculty, Pediatric Hematology Department, Istanbul, Turkey
| | - Ibrahim Eker
- Gülhane Military Medical Faculty, Pediatric Hematology Department, Ankara, Turkey
| | - Paquita Nurden
- Reference Centre for Platelet Disorders, Bordeaux University Hospital Centre, Rythmology and Cardiac Modeling Institute (LIRYC), Xavier Arnozan Hospital, Pessac, France
| | - Sophie Bayart
- Centre Régional de Traitement des Hémophiles, Centre Hospitalier Universitaire de Rennes, France
| | - Michele P Lambert
- 1 Division of Hematology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PN, USA
| | - James Bussel
- Department of Pediatrics, Division of Hematology, Weill Cornell Medicine, New York, NY, USA
| | - Barbara Zieger
- Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Germany
| | | | - Federica Melazzini
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Ana C Glembotsky
- Hematología Investigación, Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, CONICET, Argentina
| | - Alessandro Pecci
- Department of Internal Medicine, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Marco Cattaneo
- Medicina III, ASST Santi Paolo e Carlo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Nicole Schlegel
- Centre de Référence des Pathologies Plaquettaires (CRPP), Service d'Hématologie Biologique, CHU Robert Debré, AP-HP, Paris, France
| | - Paolo Gresele
- Department of Medicine, Section of Internal and Cardiovascular Medicine, University of Perugia, Italy
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Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, Mumford AD, Stanworth SJ, Tinegate H. Guidelines for the use of platelet transfusions. Br J Haematol 2016; 176:365-394. [DOI: 10.1111/bjh.14423] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lise J. Estcourt
- NHSBT and Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Janet Birchall
- NHSBT and Department of Haematology; North Bristol NHS Trust; Bristol UK
| | - Shubha Allard
- NHSBT and Department of Haematology; Royal London Hospital; London UK
| | - Stephen J. Bassey
- Department of Haematology; Royal Cornwall Hospital Trust; Cornwall UK
| | - Peter Hersey
- Department of Critical Care Medicine & Anaesthesia; City Hospitals Sunderland NHS Foundation Trust; Sunderland UK
| | - Jonathan Paul Kerr
- Department of Haematology; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine; University of Bristol; Bristol UK
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Acker JP, Marks DC, Sheffield WP. Quality Assessment of Established and Emerging Blood Components for Transfusion. JOURNAL OF BLOOD TRANSFUSION 2016; 2016:4860284. [PMID: 28070448 PMCID: PMC5192317 DOI: 10.1155/2016/4860284] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/02/2016] [Indexed: 12/16/2022]
Abstract
Blood is donated either as whole blood, with subsequent component processing, or through the use of apheresis devices that extract one or more components and return the rest of the donation to the donor. Blood component therapy supplanted whole blood transfusion in industrialized countries in the middle of the twentieth century and remains the standard of care for the majority of patients receiving a transfusion. Traditionally, blood has been processed into three main blood products: red blood cell concentrates; platelet concentrates; and transfusable plasma. Ensuring that these products are of high quality and that they deliver their intended benefits to patients throughout their shelf-life is a complex task. Further complexity has been added with the development of products stored under nonstandard conditions or subjected to additional manufacturing steps (e.g., cryopreserved platelets, irradiated red cells, and lyophilized plasma). Here we review established and emerging methodologies for assessing blood product quality and address controversies and uncertainties in this thriving and active field of investigation.
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Affiliation(s)
- Jason P. Acker
- Centre for Innovation, Canadian Blood Services, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Denese C. Marks
- Research and Development, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - William P. Sheffield
- Centre for Innovation, Canadian Blood Services, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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Fedele PL, Polizzotto MN, Grigoriadis G, Waters N, Comande M, Borosak M, Portbury D, Wood EM. Profiling clinical platelet and plasma use to inform blood supply and contingency planning: PUPPY, the prospective utilization of platelets and plasma study. Transfusion 2016; 56:2455-2465. [PMID: 27600298 DOI: 10.1111/trf.13778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/04/2016] [Accepted: 06/05/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Demand for platelet (PLT) and plasma transfusions is increasing. Improved clinical supply and contingency planning requires greater understanding of usage profiles and urgency of clinical requirement. STUDY DESIGN AND METHODS This study was a random-sample survey of PLT and plasma units produced in Victoria, Australia, to determine product disposition, recipient demographics, clinical indications for transfusion, and urgency (or "deferability") of need. PLTs and fresh-frozen plasma (FFP) were tagged with a case report form before distribution. RESULTS A total of 1252 PLT and 1837 FFP units were tagged, comprising 8.3 and 13.3% of all products issued during the study period. The fate of 1243 PLT and 1808 FFP units was determined. Of products issued, 72.2% of PLTs and 87.8% of FFP were transfused. Hematologic and oncologic disorders accounted for 63.9% of PLT transfusions, with acute myeloid leukemia alone accounting for 26%. Conversely, surgical patients received the largest proportion of FFP (40.4%), predominantly for cardiothoracic, solid organ transplant, and vascular surgery. Approximately 15% of PLT transfusions and 35% of plasma transfusions were required within 1 hour, and 80% of PLT transfusions and 90% of FFP transfusions were required within 24 hours. Wastage rates were higher in regional blood banks. CONCLUSION The PUPPY study is a comprehensive and detailed population-based assessment of PLT and plasma usage, including urgency of use. It identifies specific clinical areas with high demand for PLT and FFP transfusion and demonstrates the high urgency of need for both products. These data inform clinical supply and contingency planning activities.
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Affiliation(s)
- Pasquale L Fedele
- The Australian Red Cross Blood Service, Melbourne, Australia.
- Monash Haematology, Parkville.
- Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
| | - Mark N Polizzotto
- The Australian Red Cross Blood Service, Melbourne, Australia
- Kirby Institute for Infection and Immunity, University of New South Wales
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - George Grigoriadis
- The Australian Red Cross Blood Service, Melbourne, Australia
- Monash Haematology, Parkville
- School of Clinical Sciences, Monash Health, Clayton, Australia
| | - Neil Waters
- The Australian Red Cross Blood Service, Melbourne, Australia
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mary Comande
- The Australian Red Cross Blood Service, Melbourne, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Marija Borosak
- The Australian Red Cross Blood Service, Melbourne, Australia
- Department of Haematology, Eastern Health, Box Hill, Australia
| | - David Portbury
- The Australian Red Cross Blood Service, Melbourne, Australia
| | - Erica M Wood
- The Australian Red Cross Blood Service, Melbourne, Australia.
- Monash Haematology, Parkville.
- School of Clinical Sciences, Monash Health, Clayton, Australia.
- Transfusion Research Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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28
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Desborough MJR, Smethurst PA, Estcourt LJ, Stanworth SJ. Alternatives to allogeneic platelet transfusion. Br J Haematol 2016; 175:381-392. [PMID: 27650431 DOI: 10.1111/bjh.14338] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Allogeneic platelet transfusions are widely used for the prevention and treatment of bleeding in thrombocytopenia. Recent evidence suggests platelet transfusions have limited efficacy and are associated with uncertain immunomodulatory risks and concerns about viral or bacterial transmission. Alternatives to transfusion are a well-recognised tenet of Patient Blood Management, but there has been less focus on different strategies to reduce bleeding risk by comparison to platelet transfusion. Direct alternatives to platelet transfusion include agents to stimulate endogenous platelet production (thrombopoietin mimetics), optimising platelet adhesion to endothelium by treating anaemia or increasing von Willebrand factor levels (desmopressin), increasing formation of cross-linked fibrinogen (activated recombinant factor VII, fibrinogen concentrate or recombinant factor XIII), decreasing fibrinolysis (tranexamic acid or epsilon aminocaproic acid) or using artificial or modified platelets (cryopreserved platelets, lyophilised platelets, haemostatic particles, liposomes, engineered nanoparticles or infusible platelet membranes). The evidence base to support the use of these alternatives is variable, but an area of active research. Much of the current randomised controlled trial focus is on evaluation of the use of thrombopoietin mimetics and anti-fibrinolytics. It is also recognised that one alternative strategy to platelet transfusion is choosing not to transfuse at all.
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Affiliation(s)
- Michael J R Desborough
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK. .,Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK.
| | | | - Lise J Estcourt
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.,Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - Simon J Stanworth
- NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.,Oxford Clinical Research in Transfusion Medicine, Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
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29
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Berger K, Schopohl D, Wittmann G, Schramm W, Ostermann H, Rieger C. Blood Product Supply in Germany: The Impact of Apheresis and Pooled Platelet Concentrates. Transfus Med Hemother 2016; 43:389-394. [PMID: 27994524 DOI: 10.1159/000445442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/02/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Germany, about 60% of all produced platelet concentrates (PCs) are apheresis PCs (APCs). Ongoing discussions on APC reimbursement and costs might lead to a potential shift in pooled PC (PPC)/APC production. Objective of this analysis was to build a comprehensive model from the societal perspective to evaluate consequences associated with shifts in platelet supply and demand. METHODS Literature search, desktop researches on platelet supply and demand. Model calculations, time horizon one year: model input from the Paul-Ehrlich-Institute, data 2013. Base case: 19.2% of annual whole blood donations (WBDs) were used for production of 38.5% PPCs, decay of 46,218 PCs (8.0%). Scenarios calculated: variation in PPC proportion of 10-100%. RESULTS Base case: during PPC production 41,957-83,913 red blood cell concentrates (RBCCs) are estimated to be lost, which corresponds to 1-2% of annual RBCCs in Germany. Scenarios were calculated for a production of 60-100% PPCs: loss is estimated to be 1.5-5.0% of annual RBCCs (65,430-218,099), decay 54,189-69,022 PCs (9.4-12.0%). CONCLUSION Production of different blood components is interlinked and sensitive to unidimensional decisions. Increasing PPC proportion has negative impact on the RBCC production and on the antigen-matched APC donor pool. Completion of the model calculations to predict the optimal PPC/APC proportion would require evidence on the number of refractory patients, donor pool sizes, and incidences of diseases requiring platelet transfusions.
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Affiliation(s)
- Karin Berger
- Department of Hematology/Oncology, University Hospital of Munich, Munich, Germany
| | - Dorothee Schopohl
- Department of Hematology/Oncology, University Hospital of Munich, Munich, Germany
| | - Georg Wittmann
- Department of Transfusion Medicine, Cell Therapeutics and Hemostaseology, University Hospital of Munich, Munich, Germany
| | | | - Helmut Ostermann
- Department of Hematology/Oncology, University Hospital of Munich, Munich, Germany
| | - Christina Rieger
- Department of Hematology/Oncology, University Hospital of Munich, Munich, Germany
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Platelet Transfusions in the PICU: Tiny Cells, Big Issue. Pediatr Crit Care Med 2016; 17:897-9. [PMID: 27585046 DOI: 10.1097/pcc.0000000000000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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O'Riordan J, Boland F, Williams P, Donnellan J, Hogema BM, Ijaz S, Murphy WG. Hepatitis E virus infection in the Irish blood donor population. Transfusion 2016; 56:2868-2876. [DOI: 10.1111/trf.13757] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Joan O'Riordan
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Fiona Boland
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Padraig Williams
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Joe Donnellan
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
| | - Boris M. Hogema
- Departments of Blood-borne Infections and Virology; Sanquin Research and Diagnostic Services; Amsterdam the Netherlands
| | - Samreen Ijaz
- Blood Borne Virus Unit, Virus Reference Department; National Infection Service, Public Health England; London UK
| | - William G. Murphy
- Irish Blood Transfusion Service, National Blood Centre; Dublin Ireland
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32
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Sekhar M, Clark S, Atugonza R, Li A, Chaudhry Z. Effective implementation of a patient blood management programme for platelets. Transfus Med 2016; 26:422-431. [DOI: 10.1111/tme.12331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 01/22/2023]
Affiliation(s)
- M. Sekhar
- Department of Haematology; Royal Free London NHS Trust; London UK
| | - S. Clark
- Department of Haematology; Royal Free London NHS Trust; London UK
| | - R. Atugonza
- Department of Haematology; Royal Free London NHS Trust; London UK
| | - A. Li
- Department of Haematology; Royal Free London NHS Trust; London UK
| | - Z. Chaudhry
- Department of Haematology; Royal Free London NHS Trust; London UK
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Baharoglu MI, Cordonnier C, Al-Shahi Salman R, de Gans K, Koopman MM, Brand A, Majoie CB, Beenen LF, Marquering HA, Vermeulen M, Nederkoorn PJ, de Haan RJ, Roos YB. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016; 387:2605-2613. [PMID: 27178479 DOI: 10.1016/s0140-6736(16)30392-0] [Citation(s) in RCA: 443] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, reduced death or dependence after intracerebral haemorrhage associated with antiplatelet therapy use. METHODS We did this multicentre, open-label, masked-endpoint, randomised trial at 60 hospitals in the Netherlands, UK, and France. We enrolled adults within 6 h of supratentorial intracerebral haemorrhage symptom onset if they had used antiplatelet therapy for at least 7 days beforehand and had a Glasgow Coma Scale score of at least 8. With use of a secure web-based system that concealed allocation and used biased coin randomisation, study collaborators randomly assigned participants (1:1; stratified by hospital and type of antiplatelet therapy) to receive either standard care or standard care with platelet transfusion within 90 min of diagnostic brain imaging. Participants and local investigators giving interventions were not masked to treatment allocation, but allocation was concealed from outcome assessors and investigators analysing data. The primary outcome was shift towards death or dependence rated on the modified Rankin Scale (mRS) at 3 months, and analysed by ordinal logistic regression, adjusted for stratification variables and the Intracerebral Haemorrhage Score. The primary analysis was done in the intention-to-treat population and safety analyses were done in the intention-to-treat and as-treated populations. This trial is registered with the Netherlands Trial Register, number NTR1303, and is now closed. FINDINGS Between Feb 4, 2009, and Oct 8, 2015, 41 sites enrolled 190 participants. 97 participants were randomly assigned to platelet transfusion and 93 to standard care. The odds of death or dependence at 3 months were higher in the platelet transfusion group than in the standard care group (adjusted common odds ratio 2·05, 95% CI 1·18-3·56; p=0·0114). 40 (42%) participants who received platelet transfusion had a serious adverse event during their hospital stay, as did 28 (29%) who received standard care. 23 (24%) participants assigned to platelet transfusion and 16 (17%) assigned to standard care died during hospital stay. INTERPRETATION Platelet transfusion seems inferior to standard care for people taking antiplatelet therapy before intracerebral haemorrhage. Platelet transfusion cannot be recommended for this indication in clinical practice. FUNDING The Netherlands Organisation for Health Research and Development, Sanquin Blood Supply, Chest Heart and Stroke Scotland, French Ministry of Health.
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Affiliation(s)
- M Irem Baharoglu
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Charlotte Cordonnier
- Université Lille, Inserm U1171, Degenerative and Vascular Cognitive Disorders, CHU Lille, Department of Neurology, Lille, France
| | | | - Koen de Gans
- Department of Neurology, Groene Hart Ziekenhuis, Gouda, Netherlands
| | | | | | - Charles B Majoie
- Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands
| | - Ludo F Beenen
- Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands
| | - Henk A Marquering
- Department of Radiology, Academic Medical Centre, Amsterdam, Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Centre, Amsterdam, Netherlands
| | - Marinus Vermeulen
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Centre, Amsterdam, Netherlands
| | - Yvo B Roos
- Department of Neurology, Academic Medical Centre, Amsterdam, Netherlands.
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34
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Perspectives on the use of biomaterials to store platelets for transfusion. Biointerphases 2016; 11:029701. [DOI: 10.1116/1.4952450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Crighton GL, Estcourt LJ, Wood EM, Stanworth SJ. Platelet Transfusions in Patients with Hypoproliferative Thrombocytopenia. Hematol Oncol Clin North Am 2016; 30:541-60. [DOI: 10.1016/j.hoc.2016.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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36
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Kasivisvanathan R, Koutra M, Rooms M, Black E, Desai L, Mallett SV, Rao-Baikady R. Thromboelastography (TEG®) compared with total platelet count in thrombocytopenia haematological malignancy patients with bleeding: a pilot observational study. Transfus Med 2015; 25:307-12. [DOI: 10.1111/tme.12221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 11/26/2022]
Affiliation(s)
- R. Kasivisvanathan
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - M. Koutra
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - M. Rooms
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
| | - E. Black
- Department of Research and Development; The Royal Marsden NHS Foundation Trust; London UK
| | - L. Desai
- Transfusion Laboratory; The Royal Marsden NHS Foundation Trust; London UK
| | - S. V. Mallett
- Department of Anaesthesia and Perioperative Care; The Royal Free NHS Foundation Trust; London UK
| | - R. Rao-Baikady
- Department of Anaesthesia and Perioperative Care; The Royal Marsden NHS Foundation Trust; London UK
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37
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Hall S, Murphy MF. Limitations of component therapy for massive haemorrhage: is whole blood the whole solution? Anaesthesia 2015; 70:511-4. [DOI: 10.1111/anae.13071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S. Hall
- NHS Blood and Transplant; John Radcliffe Hospital; Oxford UK
| | - M. F. Murphy
- University of Oxford; Oxford UK
- NHS Blood and Transplant and Oxford University Hospitals; Oxford UK
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38
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Estcourt LJ. Why has demand for platelet components increased? A review. Transfus Med 2014; 24:260-8. [DOI: 10.1111/tme.12155] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/24/2014] [Accepted: 09/06/2014] [Indexed: 01/16/2023]
Affiliation(s)
- L. J. Estcourt
- NHS Blood and Transplant; Oxford UK
- Radcliffe Department of Medicine; University of Oxford; Oxford UK
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