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Cid J, Charry P, Lozano M. Therapeutic efficacy and safety of pathogen-reduced platelet components: Results of a meta-analysis of randomized controlled trials. Vox Sang 2024; 119:203-211. [PMID: 38181391 DOI: 10.1111/vox.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Clinical efficacy and safety of pathogen-reduced platelet concentrates (PR-PCs) concerning bleeding prevention are still debated despite conclusive real-world data from multiple countries where PR-PCs are transfused routinely. We performed a meta-analysis of randomized controlled trials (RCTs) comparing the clinical efficacy and safety of conventional platelet components (PCs) and PR-PCs prepared with the amotosalen/ultraviolet A light (INTERCEPT platelet concentrate [I-PC]) or riboflavin/ultraviolet light (Mirasol platelet concentrate [M-PC]) technologies, transfused in thrombocytopenic adult patients. MATERIALS AND METHODS A literature search was conducted, and 10 RCTs met the criteria for inclusion in this meta-analysis. Summary odds ratios (ORs) of clinically significant bleeding (World Health Organization [WHO] bleeding grade ≥2), severe bleeding (WHO bleeding score ≥3) and all-cause mortality were calculated. RESULTS The use of I-PC was not associated with an increase in the OR of clinically significant bleeding when compared to non-treated PCs (OR, 1.12; 95% CI: 0.89-1.41; p = 0.33), whereas transfusions with M-PC showed an increase in clinically significant bleeding (OR, 1.34; 95% CI: 1.03-1.75; p = 0.03). The OR of severe bleeding did not increase with either I-PC or M-PC (OR 0.88; 95% CI: 0.59-1.31; p = 0.52 for I-PC; OR 1.25; 95% CI: 0.66-2.37; p = 0.49 for M-PC). In the case of all-cause mortality, compared to non-treated PC, I-PC showed an OR of 0.61 (95% CI: 0.36-1.04; p = 0.07), and M-PC showed an OR of 3.04 (95% CI: 0.81-11.47; p = 0.1). CONCLUSION No differences were observed concerning the clinical efficacy and safety of overall PR-PCs when compared to non-treated PCs. However, differences are evident when analysing platelets prepared with the two PR technologies independently.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Paola Charry
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic, University of Barcelona, Barcelona, Spain
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Koepsell SA, Stolla M, Sedjo RL, Carson J, Knudson M, Cook R, Fasano R, Ngamsuntikul SG, Cohn C, Gorlin J, Delaney M, Slichter S, Ness P, McCullough J. Results of clinical effectiveness of conventional versus Mirasol-treated Apheresis Platelets in Patients with Hypoproliferative Thrombocytopenia (MiPLATE) trial. Transfusion 2024; 64:457-465. [PMID: 38314476 DOI: 10.1111/trf.17720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/27/2023] [Accepted: 12/24/2023] [Indexed: 02/06/2024]
Abstract
BACKGROUND The Mirasol® Pathogen Reduction Technology System was developed to reduce transfusion-transmitted diseases in platelet (PLT) products. STUDY DESIGN AND METHODS MiPLATE trial was a prospective, multicenter, controlled, randomized, non-inferiority (NI) study of the clinical effectiveness of conventional versus Mirasol-treated Apheresis PLTs in participants with hypoproliferative thrombocytopenia. The novel primary endpoint was days of ≥Grade 2 bleeding with an NI margin of 1.6. RESULTS After 330 participants were randomized, a planned interim analysis of 297 participants (145 MIRASOL, 152 CONTROL) receiving ≥1 study transfusion found a 2.79-relative rate (RR) in the MIRASOL compared to the CONTROL in number of days with ≥Grade 2 bleeding (95% confidence interval [CI] 1.67-4.67). The proportion of subjects with ≥Grade 2 bleeding was 40.0% (n = 58) in MIRASOL and 30.3% (n = 46) in CONTROL (RR = 1.32, 95% CI 0.97-1.81, p = .08). Corrected count increments were lower (p < .01) and the number of PLT transfusion episodes per participant was higher (RR = 1.22, 95% CI 1.05-1.41) in MIRASOL. There was no difference in the days of PLT support (hazard ratio = 0.86, 95% CI 0.68-1.08) or total number of red blood cell transfusions (RR = 1.12, 95% CI 0.91-1.37) between MIRASOL versus CONTROL. Transfusion emergent adverse events were reported in 119 MIRASOL participants (84.4%) compared to 133 (82.6%) participants in CONTROL (p = NS). DISCUSSION This study did not support that MIRASOL was non-inferior compared to conventional platelets using the novel endpoint number of days with ≥Grade 2 bleeding in MIRASOL when compared to CONTROL.
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Affiliation(s)
- Scott A Koepsell
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Moritz Stolla
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rebecca L Sedjo
- Clinical Research and Development, Terumo BCT, Inc., Lakewood, Colorado, USA
| | - Jeffrey Carson
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Michael Knudson
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Richard Cook
- Lifetime Scientific Inc., Waterloo, Ontario, Canada
| | - Ross Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathologyand Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | | | - Claudia Cohn
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jed Gorlin
- Memorial Blood Centers, Minneapolis, Minnesota, USA
| | - Meghan Delaney
- Department of Pathology, Children's National Hospital and The George Washington University School of Medicine, Washington, DC, USA
| | - Sherrill Slichter
- Department of Medicine, Division of Hematology, University of Washington, Seattle, Washington, USA
| | - Paul Ness
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey McCullough
- Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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Pati I, Masiello F, Pupella S, Cruciani M, De Angelis V. Efficacy and Safety of Pathogen-Reduced Platelets Compared with Standard Apheresis Platelets: A Systematic Review of RCTs. Pathogens 2022; 11:pathogens11060639. [PMID: 35745493 PMCID: PMC9231062 DOI: 10.3390/pathogens11060639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
In this systematic review, we evaluate the efficacy and safety of blood components treated with pathogen reduction technologies (PRTs). We searched the Medline, Embase, Scopus, Ovid, and Cochrane Library to identify RCTs evaluating PRTs. Risk of bias assessment and the Mantel–Haenszel method for data synthesis were used. We included in this review 19 RCTs evaluating 4332 patients (mostly oncohematological patients) receiving blood components treated with three different PRTs. Compared with standard platelets (St-PLTs), the treatment with pathogen-reduced platelets (PR-PLTs) does not increase the occurrence of bleeding events, although a slight increase in the occurrence of severe bleeding events was observed in the overall comparison. No between-groups difference in the occurrence of serious adverse events was observed. PR-PLT recipients had a lower 1 and 24 h CI and CCI. The number of patients with platelet refractoriness and alloimmunization was significantly higher in PR-PLT recipients compared with St-PLT recipients. PR-PLT recipients had a higher number of platelet and RBC transfusions compared with St-PLT recipients, with a shorter transfusion time interval. The quality of evidence for these outcomes was from moderate to high. Blood components treated with PRTs are not implicated in serious adverse events, and PR-PLTs do not have a major effect on the increase in bleeding events. However, treatment with PRTs may require a greater number of transfusions in shorter time intervals and may be implicated in an increase in platelet refractoriness and alloimmunization.
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Malvaux N, Defraigne F, Bartziali S, Bellora C, Mommaerts K, Betsou F, Schuhmacher A. In Vitro Comparative Study of Platelets Treated with Two Pathogen-Inactivation Methods to Extend Shelf Life to 7 Days. Pathogens 2022; 11:pathogens11030343. [PMID: 35335667 PMCID: PMC8949436 DOI: 10.3390/pathogens11030343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Since 2015, platelet products have been pathogen-inactivated (PI) at the Luxemburgish Red Cross (LRC) using Riboflavin and UV light (RF-PI). As the LRC should respond to hospital needs at any time, platelet production exceeds the demand, generating a discard rate of 18%. To reduce this, we consider the extension of storage time from 5 to 7 days. This study’s objective was to evaluate the in vitro 7-day platelet-storage quality, comparing two PI technologies, RF-PI and amotosalen/UVA light (AM-PI), for platelet pools from whole-blood donations (PPCs) and apheresis platelets collected from single apheresis donation (APCs). Materials and Methods: For each product type, 6 double-platelet concentrates were prepared and divided into 2 units; one was treated with RF-PI and the other by AM-PI. In vitro platelet-quality parameters were tested pre- and post-PI, at days 5 and 7. Results: Treatment and storage lesions were observed in PPCs and APCs with both PI methods. We found a higher rate of lactate increase and glucose depletion, suggesting a stronger stimulation of the glycolytic pathway, a higher Annexin V binding, and a loss of swirling in the RF-PI-treated units from day 5. The platelet loss was significantly higher in the AM-PI compared with the RF-PI units. Conclusions: Results suggest that RF-PI treatment has a higher deleterious impact on in vitro platelet quality compared to AM-PI, but we observed higher loss of platelets with AM-PI due to the post-illumination amotosalen adsorption step. If 7-day storage is needed, it can only be achieved with AM-PI, based on our quality criteria.
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Affiliation(s)
- Nicolas Malvaux
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
- Correspondence: ; Tel.: +352-2755-4000
| | - Fanette Defraigne
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Styliani Bartziali
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Camille Bellora
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
| | - Kathleen Mommaerts
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Luxembourg Center for Systems Biomedicine, 6 Av. du Swing, L-4367 Esch-sur-Alzette, Luxembourg
| | - Fay Betsou
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Laboratoire National de Sante, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg
| | - Anne Schuhmacher
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
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Garban F, Vilotitch A, Tiberghien P, Bosson JL. The impact of pathogen-reduced platelets in acute leukaemia treatment on the total blood product requirement: a subgroup analysis of an EFFIPAP randomised trial. Transfus Med 2022; 32:175-177. [PMID: 35019176 DOI: 10.1111/tme.12848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/08/2021] [Accepted: 12/30/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the impact of pathogen-reduced (PR) platelet transfusions on blood products requirement for clinical practice. BACKGROUND PR platelets are increasing in use as standard blood products. However, few randomised trials have evaluated their impact on bleeding control or prevention. Furthermore, PR platelets recirculate less than untreated platelets. METHODS A subgroup study of the randomised clinical trial EFFIPAP compared three arms of platelet preparations (PR: P-PRP/PAS, additive solution: P-PAS and plasma P-P arms respectively). The subgroup of acute leukaemia patients, in their chemotherapy induction phase, included 392 patients (133 P-PRP/PAS arm, 132 P-PAS arm and 130 P-P arm). Blood requirements were analysed across over periods of 7 days. RESULTS The number of platelet transfusions per week was significantly higher in the P-PRP/PAS group 2.3 [1.6-3.3] compared to the control groups 1.9 [1.3-2.8] and 2.0 [1.3-3.0] for P-P and P-PAS groups respectively (p < 0.0001). However, the total number of platelets transfused per week was not different. The number of red blood cell concentrates (RBC) transfusion per week did not differ either. CONCLUSION In a homogeneous group of patients, platelet pathogen reduction resulted in an increased number of platelet units transfused per week while having no impact on the total number of platelets transfused or the number of RBC transfusion; resulting to an average requirement of 2 RBC and 2-3 platelets transfusions per week of marrow aplasia.
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Affiliation(s)
- Frédéric Garban
- Service d'Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France.,CNRS, UMR 5525 Translationnal innovation in Medicine and Complexity, Université Grenoble Alpes, La Tronche, France
| | - Antoine Vilotitch
- Cellule d'ingénierie des données, Centre d'Investigation Clinique 1406 - Innovation Technologique, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, Saint-Denis, France.,INSERM UMR 1098 RIGHT, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Jean Luc Bosson
- CNRS, UMR 5525 Translationnal innovation in Medicine and Complexity, Université Grenoble Alpes, La Tronche, France.,Cellule d'ingénierie des données, Centre d'Investigation Clinique 1406 - Innovation Technologique, Centre Hospitalier Universitaire de Grenoble Alpes (Grenoble Alps University Hospital), Grenoble, France
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Arcas Otero C, Pereira Saavedra A, Castrillo Fernández A, Vilariño López MD. Comparison of transfusion-outcome in patients with massive bleeding receiving pathogen-reduced platelets prepared with two different technologies. Transfus Apher Sci 2022; 61:103359. [DOI: 10.1016/j.transci.2022.103359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Escolar G, Diaz-Ricart M, McCullough J. Impact of different pathogen reduction technologies on the biochemistry, function, and clinical effectiveness of platelet concentrates: An updated view during a pandemic. Transfusion 2021; 62:227-246. [PMID: 34870335 PMCID: PMC9300014 DOI: 10.1111/trf.16747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 09/03/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022]
Abstract
Standard platelet concentrates (PCs) stored at 22°C have a limited shelf life of 5 days. Because of the storage temperature, bacterial contamination of PCs can result in life‐threatening infections in transfused patients. The potential of blood components to cause infections through contaminating pathogens or transmitting blood‐borne diseases has always been a concern. The current safety practice to prevent pathogen transmission through blood transfusion starts with a stringent screening of donors and regulated testing of blood samples to ensure that known infections cannot reach transfusion products. Pathogen reduction technologies (PRTs), initially implemented to ensure the safety of plasma products, have been adapted to treat platelet products. In addition to reducing bacterial contamination, PRT applied to PCs can extend their shelf life up to 7 days, alleviating the impact of their shortage, while providing an additional safety layer against emerging blood‐borne infectious diseases. While a deleterious action of PRTs in quantitative and qualitative aspects of plasma is accepted, the impact of PRTs on the quality, function, and clinical efficacy of PCs has been under constant examination. The potential of PRTs to prevent the possibility of new emerging diseases to reach cellular blood components has been considered more hypothetical than real. In 2019, a coronavirus‐related disease (COVID‐19) became a pandemic. This episode should help when reconsidering the possibility of future blood transmissible threats. The following text intends to evaluate the impact of different PRTs on the quality, function, and clinical effectiveness of platelets within the perspective of a developing pandemic.
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Affiliation(s)
- Gines Escolar
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
| | - Maribel Diaz-Ricart
- Department of Hematopathology, Centre Diagnostic Biomedic, Hospital Clinic, Barcelona, Spain
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8
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Liu H, Wang X. Pathogen reduction technology for blood component: A promising solution for prevention of emerging infectious disease and bacterial contamination in blood transfusion services. Journal of Photochemistry and Photobiology 2021. [DOI: 10.1016/j.jpap.2021.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Earnshaw S, Beyhaghi H, McDade C, Purser M, Marriott R, Daane L, Le Coent V, Yang J, Toback S. Clinical and economic impacts of large volume delayed sampling and pathogen reduction technology platelet processing strategies in the United States. Transfusion 2021; 61:2885-2897. [PMID: 34289101 DOI: 10.1111/trf.16589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Large volume delayed sampling (LVDS) and pathogen reduction technology (PRT) are strategies for platelet processing to minimize transfusion of contaminated platelet components (PCs). This study holistically compares the economic and clinical impact of LVDS and PRT in the United States. STUDY DESIGN AND METHODS A decision model was constructed to simulate collection, processing, and use of PCs and to compare processing strategies: PRT with 5-day shelf life, LVDS with 7-day shelf life (LVDS7), and LVDS with 5-day shelf life extended to 7 days with secondary testing (LVDS5/2). Target population was adults requiring two or more transfusions. Collection, processing, storage, and distribution data were obtained from the National Blood Collection and Utilization Survey and published literature. Patient outcomes associated with transfusions were obtained from AABB guidelines, meta-analyses, and other published clinical studies. Costs were obtained from reimbursement schedules and other published sources. RESULTS Given 10,000 donated units, 9512, 9511, and 9651 units of PRT, LVDS5/2, and LVDS7 PCs were available for transfusion, respectively. With these units, 1502, 2172, and 2329 transfusions can be performed with similar levels of adverse events. Assuming 30 transfusions a day, a hospital would require 69,325, 47,940, and 45,383 units of PRT, LVDS5/2, and LVDS7 platelets to perform these transfusions. The mean costs to perform transfusions were significantly higher with PRT units. CONCLUSIONS Compared with PRT, LVDS strategies were associated with lower costs and higher PC availability while patients experienced similar levels of adverse events. Increased utilization of LVDS has the potential to improve efficiency, expand patient access to platelets, and reduce health care costs.
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Affiliation(s)
- Stephanie Earnshaw
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Hadi Beyhaghi
- Medical Affairs, Novavax Inc, Gaithersburg, Maryland, USA
| | - Cheryl McDade
- Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Molly Purser
- Value Evidence and Outcomes, GlaxoSmithKline LLC, Upper Providence, Pennsylvania, USA
| | - Robert Marriott
- Laboratory Operations Consulting, Marriott Quality and Performance Solutions LLC, Raleigh, NC, USA
| | - Lori Daane
- Industry Healthcare Division, bioMérieux, Inc., Chicago, Illinois, USA
| | | | - Julie Yang
- Industry Healthcare Division, bioMérieux, Inc., Chicago, Illinois, USA
| | - Seth Toback
- Medical Affairs, Novavax Inc, Gaithersburg, Maryland, USA
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10
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LaFontaine PR, Yuan J, Prioli KM, Shah P, Herman JH, Pizzi LT. Economic Analyses of Pathogen-Reduction Technologies in Blood Transfusion: A Systematic Literature Review. Appl Health Econ Health Policy 2021; 19:487-499. [PMID: 33555572 DOI: 10.1007/s40258-020-00612-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Technologies used in the processing of whole blood and blood component products, including pathogen reduction, are continuously being adopted into blood transfusion workflows to improve process efficiencies. However, the economic implications of these technologies are not well understood. With the advent of these new technologies and regulatory guidance on bacterial risk-control strategies, an updated systematic literature review on this topic was warranted. OBJECTIVE The objective of this systematic literature review was to summarize the current literature on the economic analyses of pathogen-reduction technologies (PRTs). METHODS A systematic literature review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify newly published articles in PubMed, MEDLINE Complete, and EconLit from 1 January 2000 to 17 July 2019 related to economic evaluations of PRTs. Only full-text studies in humans published in English were included in the review. Both budget-impact and cost-effectiveness studies were included; common outcomes included cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The initial searches identified 433 original abstracts, of which 16 articles were included in the final data extraction and reporting. Seven articles presented cost-effectiveness analyses and nine assessed budget impact. The introduction of PRT increased overall costs, and ICER values ranged widely across cost-effectiveness studies, from below $US150,000/QALY to upwards of $US20,000,000/QALY. This wide range of results was due to a multitude of factors, including comparator selection, target patient population, and scenario analyses included. CONCLUSIONS Overall, the results of economic evaluations of bacterial risk-control strategies, regardless of mechanism, were highly dependent on the current screening protocols in place. The optimization of blood transfusion safety may not result in decisions made at the willingness-to-pay thresholds commonly seen in pharmaceutical evaluations. Given the critical public health role of blood products, and the potential safety benefits introduced by advancements, it is important to continue building this body of evidence with more transparency and data source heterogeneity. This updated literature review provides global context when making local decisions for the coverage of new and emerging bacterial risk-control strategies.
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Affiliation(s)
- Patrick R LaFontaine
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ, 08854, USA
| | - Jing Yuan
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ, 08854, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Priti Shah
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Jay H Herman
- Emeritus Director of Transfusion Medicine, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
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Abstract
Bacterial contamination of blood components is a recurrent topic in transfusion medicine community. This issue is even more important with platelet transfusions because of storage of platelet components at room temperature for 5 days. Pathogen inactivation methods are a proactive approach to deal with an infectious agent. All available methods use UV light, with or without a photosensitizer, to inactivate potential pathogens. As with other medical interventions, pathogen inactivation methods carry benefits and risks. Among benefits, inactivation of known and unknown transfusion-transmitted pathogens, inactivation of residual leukocytes, and increased storage length from 5 to 7 days are the most interesting. The main risk is the impact on clinical efficacy of pathogen-reduced platelets. After inactivation, pathogen-reduced platelets are associated with a lower number of platelets in the final product, lower 24-hour corrected count increment, and shorter transfusion interval when compared with non-inactivated platelets. However, eight of nine randomized controlled trials showed that transfusing pathogen-reduced platelets were not inferior to transfusing usual platelet components in the prevention of bleeding episodes. In conclusion, in our opinion, increasing safety of platelet transfusions with pathogen inactivation methods is worthy, even the trade-off of causing damage to platelets.
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Affiliation(s)
- Joan Cid
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
| | - Miquel Lozano
- Apheresis & Cellular Therapy Unit, Department of Hemotherapy & Hemostasis, ICMHO, IDIBAPS, UB,Hospital Clínic,Barcelona, Catalonia, Spain
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12
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Hayashi T, Oguma K, Fujimura Y, Furuta RA, Tanaka M, Masaki M, Shinbata Y, Kimura T, Tani Y, Hirayama F, Takihara Y, Takahashi K. UV light-emitting diode (UV-LED) at 265 nm as a potential light source for disinfecting human platelet concentrates. PLoS One 2021; 16:e0251650. [PMID: 34014978 PMCID: PMC8136854 DOI: 10.1371/journal.pone.0251650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022] Open
Abstract
The risk of sepsis through bacterial transmission is one of the most serious problems in platelet transfusion. In processing platelet concentrates (PCs), several methods have been put into practice to minimize the risk of bacterial transmission, such as stringent monitoring by cultivation assays and inactivation treatment by photoirradiation with or without chemical agents. As another potential option, we applied a light-emitting diode (LED) with a peak emission wavelength of 265 nm, which has been shown to be effective for water, to disinfect PCs. In a bench-scale UV-LED exposure setup, a 10-min irradiation, corresponding to an average fluence of 9.2 mJ/cm2, resulted in >2.0 log, 1.0 log, and 0.6 log inactivation (mean, n = 6) of Escherichia coli, Staphylococcus aureus, and Bacillus cereus, respectively, in non-diluted plasma PCs. After a 30-min exposure, platelet counts decreased slightly (18 ± 7%: mean ± SD, n = 7); however, platelet surface expressions of CD42b, CD61, CD62P, and PAC-1 binding did not change significantly (P>0.005), and agonist-induced aggregation and adhesion/aggregation under flow conditions were well maintained. Our findings indicated that the 265 nm UV-LED has high potential as a novel disinfection method to ensure the microbial safety of platelet transfusion.
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Affiliation(s)
- Tomoya Hayashi
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
- * E-mail:
| | | | | | - Rika A. Furuta
- Central Blood Institute, Japanese Red Cross, Tokyo, Japan
| | - Mitsunobu Tanaka
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | - Mikako Masaki
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | | | - Takafumi Kimura
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | - Yoshihiko Tani
- Central Blood Institute, Japanese Red Cross, Tokyo, Japan
| | - Fumiya Hirayama
- Japanese Red Cross Kinki Block Blood Centre, Ibaraki, Osaka, Japan
| | | | - Koki Takahashi
- Blood Service Headquarters, Japanese Red Cross, Tokyo, Japan
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13
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Brixner V, Bug G, Pohler P, Krämer D, Metzner B, Voss A, Casper J, Ritter U, Klein S, Alakel N, Peceny R, Derigs HG, Stegelmann F, Wolf M, Schrezenmeier H, Thiele T, Seifried E, Kapels HH, Döscher A, Petershofen EK, Müller TH, Seltsam A. Efficacy of UVC-treated, pathogen-reduced platelets versus untreated platelets: a randomized controlled non-inferiority trial. Haematologica 2021; 106:1086-1096. [PMID: 33538149 PMCID: PMC8018132 DOI: 10.3324/haematol.2020.260430] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 12/13/2022] Open
Abstract
Pathogen reduction (PR) technologies for blood components have been established to reduce the residual risk of known and emerging infectious agents. THERAFLEX UV-Platelets, a novel ultraviolet C (UVC) light-based PR technology for platelet concentrates, works without photoactive substances. This randomized, controlled, double-blind, multicenter, non-inferiority trial was designed to compare the efficacy and safety of UVC-treated platelets to that of untreated platelets in thrombocytopenic patients with hematologic-oncologic diseases. The primary objective was to determine non-inferiority of UVC-treated platelets, assessed by the 1-hour corrected count increment (CCI) in up to eight per-protocol platelet transfusion episodes. Analysis of the 171 eligible patients showed that the defined non-inferiority margin of 30% of UVC-treated platelets was narrowly missed as the mean differences in 1-hour CCI between standard platelets versus UVC-treated platelets for intention-to-treat and per-protocol analyses were 18.2% (95% Confidence Interval [CI]: 6.4-30.1) and 18.7% (95% CI: 6.3-31.1), respectively. In comparison to the control, the UVC group had a 19.2% lower mean 24-hour CCI and was treated with an about 25% higher number of platelet units, but the average number of days to the next platelet transfusion did not differ significantly between both treatment groups. The frequency of low-grade adverse events was slightly higher in the UVC group and the frequencies of refractoriness to platelet transfusion, platelet alloimmunization, severe bleeding events, and red blood cell transfusions were comparable between groups. Our study suggests that transfusion of pathogen-reduced platelets produced with the UVC technology is safe but non-inferiority was not demonstrated. (clinicaltrials gov. Identifier: DRKS00011156).
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Affiliation(s)
- Veronika Brixner
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | - Gesine Bug
- Department of Hematology and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt/Main
| | | | - Doris Krämer
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Bernd Metzner
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Andreas Voss
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Jochen Casper
- Department of Oncology and Hematology, University Hospital, Oldenburg
| | - Ulrich Ritter
- Department of Hematology and Oncology, Municipal Hospital Bremen, Bremen
| | - Stefan Klein
- Department of Hematology and Oncology, University Hospital, Mannheim
| | - Nael Alakel
- Medical Clinic I, Department of Hematology and Oncology, University Hospital, Carl Gustav Carus Faculty of Medicine, Dresden
| | - Rudolf Peceny
- Department of Hematology and Oncology, Municipal Hospital, Osnabrück
| | - Hans G Derigs
- Department of Hematology and Oncology, Municipal Hospital Frankfurt-Hoechst, Frankfurt/Main
| | | | - Martin Wolf
- Department of Hematology and Oncology, Municipal Hospital, Kassel
| | - Hubert Schrezenmeier
- Institute for Transfusion Medicine, University Hospital Ulm, Ulm, Germany; and Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg - Hessia, Ulm
| | - Thomas Thiele
- Institute for Immunology and Transfusion Medicine, University Medicine, Greifswald
| | - Erhard Seifried
- German Red Cross Blood Transfusion Service and Goethe University Clinics, Frankfurt/Main
| | | | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB, Springe, Germany; Bavarian Red Cross Blood Service, Nuremberg.
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14
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Prati D. Improving the safety of platelet transfusions by UV-C: Let's go back to the bench. Haematologica 2021; 106:926-927. [PMID: 33538153 PMCID: PMC8017810 DOI: 10.3324/haematol.2020.275156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Daniele Prati
- Department of Transfusion Medicine and Hematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano.
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15
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McCullough J. Pathogen Reduced Blood Products. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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16
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Abe H, Endo K, Nogawa M, Shiba M, Miyata S, Satake M. In vitro thrombus formation and in vivo hemostasis mediated by platelets irradiated with bactericidal ultraviolet C from xenon flash under flow conditions. Transfusion 2020; 61:191-201. [PMID: 33107611 DOI: 10.1111/trf.16138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously reported a flow path-ultraviolet C (UVC) irradiation system for platelet concentrates (PCs) with platelet additive solution (PAS) to minimize contamination by bacteria. Here, we investigated functionalities of irradiated platelets (PLTs) in in vitro thrombus formation and in vivo hemostasis. STUDY DESIGN AND METHODS PAS-PCs were irradiated with flash UVC using the flow path system. Their variables (PLT count, mean platelet volume, pH, glucose, lactate, glycoprotein [GP] Ib, and activated integrin αIIbβ3) were evaluated. Static adhesion to collagen or fibrinogen was analyzed using fluorescent microscopy. Thrombus formation under flow conditions was assessed using a collagen-coated bead column. Adenosine diphosphate (ADP)-induced Akt phosphorylation was determined by western blot. In vivo hemostasis and circulatory survival of PLTs were assessed with a rabbit bleeding model. RESULTS All variables, except for GPIb expression, were slightly, but significantly, impaired after flash UVC irradiation throughout the 6-day storage period. No difference was observed in static adhesion to either collagen or fibrinogen between irradiated and nonirradiated PAS-PCs. In vitro thrombus formation of flash UVC-irradiated PAS-PCs was significantly greater than that of nonirradiated PAS-PCs. ADP-induced Akt phosphorylation was enhanced in irradiated PAS-PCs. In vivo hemostatic efficacy was comparable between the groups on Day 1. The efficacy declined in nonirradiated PAS-PCs on Day 5, while it was retained in flash UVC-irradiated PAS-PCs. Circulatory survival of PLTs was lower in irradiated PAS-PCs. CONCLUSIONS PAS-PCs irradiated with UVC from xenon flash have favorable properties to achieve hemostasis compared with nonirradiated PAS-PCs.
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Affiliation(s)
- Hideki Abe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Kimika Endo
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masayuki Nogawa
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan.,Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Shiba
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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17
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Ballester-Servera C, Jimenez-Marco T, Morell-Garcia D, Quetglas-Oliver M, Bautista-Gili AM, Girona-Llobera E. Haemostatic function measured by thromboelastography and metabolic activity of platelets treated with riboflavin and UV light. Blood Transfus 2020; 18:280-9. [PMID: 32530405 DOI: 10.2450/2020.0314-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pathogen reduction technology (PRT) may damage platelet (PLT) components. To study this, metabolic activity and haemostatic function of buffy coat (BC) PLT concentrates, with or without riboflavin and UV light PRT treatment, were compared. MATERIAL AND METHODS Twenty-four BC PLT concentrates, leukoreduced and diluted in additive solution, were grouped into 12 type-matched pairs, which were pooled and divided into 12 non-PRT-treated BC PLT concentrates (control units) and 12 riboflavin and UV PRT-treated BC PLT concentrates (test units). Haemostatic function and metabolic parameters were monitored by thrombelastography at days 1, 3, 7 and 14 post collection in both PLT groups. RESULTS Loss of PLT discoid shape, glucose consumption, lactate production, and decrease in pH were greater in the PRT-treated PLTs than in control PLTs over time (p<0.001). PLT haemostatic function evaluated by clot strength was also significantly weaker in PRT-treated PLTs compared with the excellent clot quality of control PLTs at day 7 (maximum amplitude: 41.27 vs 64.27; p<0.001), and even at day 14 (21.16 vs 60.39; p<0.001) of storage. DISCUSSION Pathogen reduction technology treatment accelerates and increases platelet storage lesion, resulting in glucose depletion, lactate accumulation, PLT acidification, and discoid shape loss. The clots produced by control PLTs at day 14 were still remarkably strong, whereas at day 7 PRT-treated PLTs produced weaker clots compared to the control group. Clinical trials investigating the efficacy of PRT-treated PLTs transfused at the end of the storage period (day 7), when the in vitro clot strength is weaker, are needed.
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18
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Xu F, Feyissa Q, Ibrahim Z, Li Y, Xu KL, Guo Z, Ahmad J, Vostal JG. Inactivation of bacteria in plasma by photosensitizers benzophenone and vitamins K3, B1 and B6 with UV A light irradiation. Photodiagnosis Photodyn Ther 2020; 30:101713. [DOI: 10.1016/j.pdpdt.2020.101713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/06/2020] [Indexed: 11/22/2022]
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19
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Chipman AM, Jenne C, Wu F, Kozar RA. Contemporary resuscitation of hemorrhagic shock: What will the future hold? Am J Surg 2020; 220:580-8. [PMID: 32409009 DOI: 10.1016/j.amjsurg.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/28/2020] [Accepted: 05/07/2020] [Indexed: 02/07/2023]
Abstract
Resuscitation of the critically ill patient with fluid and blood products is one of the most widespread interventions in medicine. This is especially relevant for trauma patients, as hemorrhagic shock remains the most common cause of preventable death after injury. Consequently, the study of the ideal resuscitative product for patients in shock has become an area of great scientific interest and investigation. Recently, the pendulum has swung towards increased utilization of blood products for resuscitation. However, pathogens, immune reactions and the limited availability of this resource remain a challenge for clinicians. Technologic advances in pathogen reduction and innovations in blood product processing will allow us to increase the safety profile and efficacy of blood products, ultimately to the benefit of patients. The purpose of this article is to review the current state of blood product based resuscitative strategies as well as technologic advancements that may lead to safer resuscitation.
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20
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Heddle NM, Cardoso M, Meer PF. Revisiting study design and methodology for pathogen reduced platelet transfusions: a round table discussion. Transfusion 2020; 60:1604-1611. [DOI: 10.1111/trf.15779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 01/20/2020] [Accepted: 02/15/2020] [Indexed: 01/28/2023]
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21
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Rebulla P, Garban F, Meer PF, Heddle NM, McCullough J. A crosswalk tabular review on methods and outcomes from randomized clinical trials using pathogen reduced platelets. Transfusion 2020; 60:1267-1277. [DOI: 10.1111/trf.15791] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and HematologyFoundation IRCCS Caʼ Granda Ospedale Maggiore Policlinico Milan Italy
| | - Frederic Garban
- Department of HaematologyCentre Hospitalier Universitaire de Grenoble Alpes Grenoble France
| | - Pieter F. Meer
- Department of Product and Process DevelopmentSanquin Blood Bank Amsterdam The Netherlands
| | - Nancy M. Heddle
- Department of MedicineMcMaster University Hamilton Ontario Canada
| | - Jeffrey McCullough
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota USA
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22
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Benjamin RJ, Corash L, Norris PJ. INTERCEPT pathogen-reduced platelets are not associated with higher rates of alloimmunization with (or without) clinical refractoriness in published studies. Transfusion 2020; 60:881-882. [PMID: 32246477 DOI: 10.1111/trf.15722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Philip J Norris
- Vitalant Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
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23
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Abstract
Allogeneic platelets collected for transfusion treated with pathogen reduction technology (PRT), which has been available in some countries for more than a decade, are now increasingly available in the United States (US). The implementation of PRT-treated platelets, also known as pathogen-reduced platelets (PRPs), has been spurred by the need to further decrease the risk of sepsis associated with bacterial contamination coupled with the potential of this technology to reduce the risk of infections due to already recognized, new, and emerging infectious agents. This article will review available PRP products, examine their benefits, highlight unresolved questions surrounding this technology, and summarize pivotal research studies that have compared transfusion outcomes (largely in adult patients) for PRPs with non-PRT-treated conventional platelets (CPs). In addition, studies describing the use of PRPs in pediatric patients and work done on the association between PRPs and HLA alloimmunization are discussed. As new data emerge, it is critical to re-evaluate the risks and benefits of existing PRPs and newer technologies and reassess the financial implications of adopting PRPs to guide our decision-making process for the implementation of transfusing PRPs.
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Affiliation(s)
- Wen Lu
- Section of Transfusion Medicine, Robert Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA
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24
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Domanović D, Ushiro-Lumb I, Compernolle V, Brusin S, Funk M, Gallian P, Georgsen J, Janssen M, Jimenez-Marco T, Knutson F, Liumbruno GM, Mali P, Marano G, Maryuningsih Y, Niederhauser C, Politis C, Pupella S, Rautmann G, Saadat K, Sandid I, Sousa AP, Vaglio S, Velati C, Verdun N, Vesga M, Rebulla P. Pathogen reduction of blood components during outbreaks of infectious diseases in the European Union: an expert opinion from the European Centre for Disease Prevention and Control consultation meeting. Blood Transfus 2019; 17:433-48. [PMID: 31846608 DOI: 10.2450/2019.0288-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022]
Abstract
Pathogen reduction (PR) of selected blood components is a technology that has been adopted in practice in various ways. Although they offer great advantages in improving the safety of the blood supply, these technologies have limitations which hinder their broader use, e.g. increased costs. In this context, the European Centre for Disease Prevention and Control (ECDC), in co-operation with the Italian National Blood Centre, organised an expert consultation meeting to discuss the potential role of pathogen reduction technologies (PRT) as a blood safety intervention during outbreaks of infectious diseases for which (in most cases) laboratory screening of blood donations is not available. The meeting brought together 26 experts and representatives of national competent authorities for blood from thirteen European Union and European Economic Area (EU/EEA) Member States (MS), Switzerland, the World Health Organization, the European Directorate for the Quality of Medicines and Health Care of the Council of Europe, the US Food and Drug Administration, and the ECDC. During the meeting, the current use of PRTs in the EU/EEA MS and Switzerland was verified, with particular reference to emerging infectious diseases (see Appendix). In this article, we also present expert discussions and a common view on the potential use of PRT as a part of both preparedness and response to threats posed to blood safety by outbreaks of infectious disease.
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25
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Escolar G, McCullough J. Platelet in vitro assays: their correspondence with their in vivo hemostatic potential. Transfusion 2019; 59:3783-3793. [PMID: 31642072 DOI: 10.1111/trf.15559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/26/2019] [Accepted: 08/28/2019] [Indexed: 01/01/2023]
Abstract
Developments during the past few years have resulted in multiple kinds of platelet products for transfusion. This involves different collection methods, containers, preservative solutions, modifications of storage temperatures and durations, and additional treatments such as pathogen reduction. Much experience has been obtained testing these processes in vitro to seek indications of in vivo effectiveness. Availability of an in vitro method that correlated with in vivo effectiveness would be extremely valuable for these different kinds of platelet products and as more innovation in platelet preparation occurs in the future. This report reviews the methods for in vitro platelet testing with a view to their in vivo implications and whether such testing could be helpful in projecting the clinical effectiveness of different platelet products.
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Affiliation(s)
- Gines Escolar
- Department of Hemotherapy and Hemostasis, ICMHO, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Jeffrey McCullough
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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26
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27
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Infanti L, Holbro A, Passweg J, Bolliger D, Tsakiris DA, Merki R, Plattner A, Tappe D, Irsch J, Lin JS, Corash L, Benjamin RJ, Buser A. Clinical impact of amotosalen-ultraviolet A pathogen-inactivated platelets stored for up to 7 days. Transfusion 2019; 59:3350-3361. [PMID: 31574181 PMCID: PMC6900102 DOI: 10.1111/trf.15511] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/07/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Universal pathogen inactivation of platelet concentrates (PCs) using amotosalen/ultraviolet A with 7‐day storage was implemented in Switzerland in 2011. Routine‐use data were analyzed at the University Hospital Basel, Switzerland. STUDY DESIGN A retrospective two‐cohort study of patient and PC characteristics, component usage, patient outcomes, count increments (CIs), and adverse events were analyzed for two consecutive 5‐year periods with either 0‐ to 5‐day‐old conventional PC (C‐PC) (n = 14,181) or 0‐ to 7‐day‐old pathogen‐inactivated PC (PI‐PC) (n = 22,579). RESULTS In both periods, PCs were issued for transfusion on a “first in, first out” basis. With 7‐day PI‐PC, wastage was reduced from 8.7% to 1.5%; 16.6% of transfused PI‐PCs were more than 5 days old. Transfusion of PI‐PC more than 5 days old compared with 5 days old or less did not increase platelet and RBC use on the same or next day as an indirect measure of hemostasis and did not increase transfusion reactions. Mean corrected count increments (CCIs) for PI‐PC stored for 5 days or less were 22.6% lower than for C‐PC (p < 0.001), and declined with increasing storage duration for both, although the correlation was weak (r2 = 0.005‐0.014). Mean number of PCs used per patient and duration of PC support were not different for hematology/oncology, allogeneic and autologous hematopoietic stem cell transplant (HSCT), and general medical/surgical patients, who used the majority (~92.0%) of PI‐PCs. Five‐year treatment‐related mortality in allogeneic HSCT was unchanged in the PI‐PC period. CONCLUSIONS PI‐PCs with 7‐day storage reduced wastage and did not increase PC or red blood cell utilization or adverse reactions compared with fresh PI‐PC or a historical control group, demonstrating preserved efficacy and safety.
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Affiliation(s)
- Laura Infanti
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland.,Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department for Anesthesia, Prehospital Emergency Medicine, and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Ramona Merki
- Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | | | | | | | | | - Andreas Buser
- Regional Blood Transfusion Service, Swiss Red Cross, Basel, Switzerland.,Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
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28
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Bahar B, Schulz WL, Gokhale A, Spencer BR, Gehrie EA, Snyder EL. Blood utilisation and transfusion reactions in adult patients transfused with conventional or pathogen-reduced platelets. Br J Haematol 2019; 188:465-472. [PMID: 31566724 PMCID: PMC7003815 DOI: 10.1111/bjh.16187] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/27/2019] [Indexed: 01/23/2023]
Abstract
Pathogen-reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR platelets when compared to conventional (CONV) platelets. Over a 28-month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale-New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time-to-next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non-septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.
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Affiliation(s)
- Burak Bahar
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Wade L Schulz
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Amit Gokhale
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
| | | | - Eric A Gehrie
- Department of Pathology and Laboratory Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward L Snyder
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA
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29
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Abonnenc M, Crettaz D, Sonego G, Escolar G, Tissot JD, Prudent M. Towards the understanding of the UV light, riboflavin and additive solution contributions to the in vitro lesions observed in Mirasol®-treated platelets. Transfus Clin Biol 2019; 26:209-216. [PMID: 31563447 DOI: 10.1016/j.tracli.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/07/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Pathogen reduction technologies are implemented to increase the safety of blood products. We previously showed that the UVB alone significantly contributes to the storage lesions observed in platelets treated with riboflavin/UVB using a home-made illuminator. The present study aims at confirming these observations using the commercial Mirasol® technology. METHODS A three-arm study (untreated, UV-, Mirasol®-treated platelets) was conducted to investigate the platelet storage lesions throughout storage (n=4). A two-arm study was then designed to compare Intersol and T-PAS+ additive solutions (n=3). Phenotype and functional platelet characteristics were assessed using flow cytometry, aggregometry, antioxidant assays and metabolic parameters. RESULTS Mirasol®-treated platelets exhibit enhanced storage lesions compared to controls (increase of activation markers and glycolysis rate, lower hypotonic shock and double-agonist activation responses, and decrease of total antioxidant capacity). Here, we also confirmed that the UV radiation alone is causing platelet lesions. Riboflavin tends to have an intracellular protective role while it decreases the extracellular antioxidant defenses. Furthermore, benefits of platelet additive solutions containing potassium and magnesium were confirmed as it reduces the extent of storage lesions. CONCLUSIONS The photosensitizer, UV illumination and composition of the platelet additive solutions are key parameters influencing the platelet storage lesion. The clinical relevance of these findings is not fully understood and recent published clinical studies could not show increase in bleeding in patients receiving Mirasol-treated platelets. New developments in storage solutions might help to improve storage conditions of PRT-treated platelets and should be prioritised as research subject in the future.
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Affiliation(s)
- M Abonnenc
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland
| | - D Crettaz
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland
| | - G Sonego
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland
| | - G Escolar
- Department of Hematopathology, Hospital Clinic of Barcelona, Biomedical Diagnosis Centre (CDB), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J-D Tissot
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland; Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - M Prudent
- Laboratoire de Recherche sur les Produits Sanguins, Recherche et Développement Produits, Transfusion Interrégionale CRS, Epalinges, Switzerland; Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland.
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Rebulla P. The long and winding road to pathogen reduction of platelets, red blood cells and whole blood. Br J Haematol 2019; 186:655-667. [PMID: 31304588 DOI: 10.1111/bjh.16093] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
Pathogen reduction technologies (PRTs) have been developed to further reduce the current very low risks of acquiring transfusion-transmitted infections and promptly respond to emerging infectious threats. An entire portfolio of PRTs suitable for all blood components is not available, but the field is steadily progressing. While PRTs for plasma have been used for many years, PRTs for platelets, red blood cells (RBC) and whole blood (WB) were developed more slowly, due to difficulties in preserving cell functions during storage. Two commercial platelet PRTs use ultra violet (UV) A and UVB light in the presence of amotosalen or riboflavin to inactivate pathogens' nucleic acids, while a third experimental PRT uses UVC light only. Two PRTs for WB and RBC have been tested in experimental clinical trials with storage limited to 21 or 35 days, due to unacceptably high RBC storage lesion beyond these time limits. This review summarizes pre-clinical investigations and selected outcomes from clinical trials using the above PRTs. Further studies are warranted to decrease cell storage lesions after PRT treatment and to test PRTs in different medical and surgical conditions. Affordability remains a major administrative obstacle to PRT use, particularly so in geographical regions with higher risks of transfusion-transmissible infections.
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Affiliation(s)
- Paolo Rebulla
- Department of Transfusion Medicine and Haematology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
Pediatric oncology patients will likely require numerous transfusions of blood products, including red blood cell, platelet, and plasma transfusions, during the course of their treatment. Although strong evidence-based guidelines for these products in this patient population do not exist, given the morbidities associated with the receipt of blood products, practitioners should attempt to use restrictive transfusion strategies.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schulz WL, McPadden J, Gehrie EA, Bahar B, Gokhale A, Ross R, Price N, Spencer BR, Snyder E. Blood Utilization and Transfusion Reactions in Pediatric Patients Transfused with Conventional or Pathogen Reduced Platelets. J Pediatr 2019; 209:220-225. [PMID: 30885645 DOI: 10.1016/j.jpeds.2019.01.046] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of a Food and Drug Administration-approved pathogen-reduced platelet (PLT) product in children, as ongoing questions regarding their use in this population remain. STUDY DESIGN We report findings from a quality assurance review of PLT utilization, associated red blood cell transfusion trends, and short-term safety of conventional vs pathogen-reduced PLTs over a 21-month period while transitioning from conventional to pathogen-reduced PLTs at a large, tertiary care hospital. We assessed utilization in neonatal intensive care unit (NICU) patients, infants 0-1 year not in the NICU, and children age 1-18 years (PED). RESULTS In the 48 hours after an index conventional or pathogen-reduced platelet transfusion, respectively, NICU patients received 1.0 ± 1.4 (n = 91 transfusions) compared with 1.2 ± 1.3 (n = 145) additional platelet doses (P = .29); infants 0-1 year not in the NICU received 2.8 ± 3.0 (n = 125) vs 2.6 ± 2.6 (n = 254) additional platelet doses (P = .57); and PEDs received 0.9 ± 1.6 (n = 644) vs 1.4 ± 2.2 (n = 673) additional doses (P < .001). Time to subsequent transfusion and red cell utilization were similar in every group (P > .05). The number and type of transfusion reactions did not significantly vary based on PLT type and no rashes were reported in NICU patients receiving phototherapy and pathogen-reduced PLTs. CONCLUSIONS Conventional and pathogen-reduced PLTs had similar utilization patterns in our pediatric populations. A small, but statistically significant, increase in transfusions was noted following pathogen-reduced PLT transfusion in PED patients, but not in other groups. Red cell utilization and transfusion reactions were similar for both products in all age groups.
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Affiliation(s)
- Wade L Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Jacob McPadden
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Eric A Gehrie
- Department of Pathology and Surgery, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Burak Bahar
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT
| | - Amit Gokhale
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT; Department of Pathology, Stony Brook School of Medicine
| | - Rebecca Ross
- Blood Bank, Yale New Haven Hospital, New Haven, CT
| | - Nathaniel Price
- Information Technology Services, Yale New Haven Health, New Haven, CT
| | | | - Edward Snyder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT.
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Saris A, Kerkhoffs JL, Norris PJ, van Ham SM, Ten Brinke A, Brand A, van der Meer PF, Zwaginga JJ. The role of pathogen-reduced platelet transfusions on HLA alloimmunization in hemato-oncological patients. Transfusion 2018; 59:470-481. [PMID: 30499599 DOI: 10.1111/trf.15056] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Platelet transfusions can induce alloimmunization against HLA antigens. The use of pathogen-reduced platelet concentrates (PCs) was suggested to reduce HLA alloimmunization and concomitant transfusion refractoriness. METHODS This study investigated HLA alloimmunization in available samples from 448 hemato-oncological patients who were randomized for the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) trial to receive either untreated or pathogen-reduced PCs (Mirasol, Terumo BCT Inc.). Anti-HLA Class I and II antibodies were determined before the first platelet transfusion and weekly thereafter using multiplex assay with standard cutoffs to detect low- as well as high-level antibodies. RESULTS When using the lower cutoff, in patients who were antibody negative at enrollment, 5.4% (n = 12) developed anti-HLA Class I antibodies after receiving untreated PCs, while this was significantly higher in patients receiving pathogen-reduced PCs, 12.8% (n = 29; p = 0.009, intention-to-treat [ITT] analysis). A similar but nonsignificant trend was observed in the per-protocol (PP) analysis (5.4% vs. 10.1%; p = 0.15). HLA class II antibody formation was similar between both types of PCs in the ITT analysis, while the PP analysis showed a trend toward lower immunization after receiving pathogen-reduced PCs. Multivariate analysis identified receiving pathogen-reduced platelets as an independent risk factor for HLA Class I alloimmunization (ITT: odds ratio [95% confidence interval] = 3.02 [1.42-6.51], PP: odds ratio [95% confidence interval] = 2.77 [1.00-5.40]), without affecting HLA Class II alloimmunization. When using the high cutoff value, the difference in HLA Class I alloimmunization between study arms remained significant in the ITT analysis and again was not significant in the PP analysis. CONCLUSION Our data clearly indicate that Mirasol pathogen inactivation does not prevent HLA Class I or II alloimmunization after platelet transfusions.
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Affiliation(s)
- Anno Saris
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean Louis Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Philip J Norris
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California
| | - S Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Ten Brinke
- Department of Immunopathology, Sanquin Research, Amsterdam, The Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Anneke Brand
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter F van der Meer
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Jon J. van Rood Center for Clinical Transfusion Science, Leiden University Medical Center, Leiden, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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36
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Vossier L, Valera L, Leon F, Roche S, Piquer D, Rubrecht L, Favier C, Cremer GA, Pouzet A, Dagland T, Rihet S, Galea P, Farre C, Bonnet R, Jaffrézic-Renault N, Chaix C, Fareh J, Fournier-Wirth C. Combining culture and microbead-based immunoassay for the early and generic detection of bacteria in platelet concentrates. Transfusion 2018; 59:277-286. [PMID: 30430585 DOI: 10.1111/trf.15019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/16/2018] [Accepted: 07/22/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite current preventive strategies, bacterial contamination of platelets is the highest residual infectious risk in transfusion. Bacteria can grow from an initial concentration of 0.03-0.3 colony-forming units (CFUs)/mL up to 108 to 109 CFUs/mL over the product shelf life. The aim of this study was to develop a cost-effective approach for an early, rapid, sensitive, and generic detection of bacteria in platelet concentrates. STUDY DESIGN AND METHODS A large panel of bacteria involved in transfusion reactions, including clinical isolates and reference strains, was established. Sampling was performed 24 hours after platelet spiking. After an optimized culture step for increasing bacterial growth, a microbead-based immunoassay allowed the generic detection of bacteria. Antibody production and immunoassay development took place exclusively with bacteria spiked in fresh platelet concentrates to improve the specificity of the test. RESULTS Antibodies for the generic detection of either gram-negative or gram-positive bacteria were selected for the microbead-based immunoassay. Our approach, combining the improved culture step with the immunoassay, allowed sensitive detection of 1 to 10 CFUs/mL for gram-negative and 1 to 102 CFUs/mL for gram-positive species. CONCLUSION In this study, a new approach combining bacterial culture with immunoassay was developed for the generic and sensitive detection of bacteria in platelet concentrates. This efficient and easily automatable approach allows tested platelets to be used on Day 2 after collection and could represent an alternative strategy for reducing the risk of transfusion-transmitted bacterial infections. This strategy could be adapted for the detection of bacteria in other cellular products.
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Affiliation(s)
- Ludivine Vossier
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
| | - Lionel Valera
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Fanny Leon
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
| | - Stéphanie Roche
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Dominique Piquer
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Laetitia Rubrecht
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Christine Favier
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | | | - Agnès Pouzet
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Typhaine Dagland
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Stéphane Rihet
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Pascale Galea
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Carole Farre
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | - Romaric Bonnet
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | | | - Carole Chaix
- Institut des Sciences Analytiques, (CNRS-Université de Lyon 1-ENS), Lyon, France
| | - Jeannette Fareh
- Bio-Rad, R&D Marnes la Coquette, Steenvoorde and, Montpellier, France
| | - Chantal Fournier-Wirth
- Pathogenesis and Control of Chronic Infections, EFS, Inserm, Université de Montpellier, Montpellier, France
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Lotens A, de Valensart N, Najdovski T, Acquart S, Cognasse F, Rapaille A. Influence of platelet preparation techniques on in vitro storage quality after psoralen-based photochemical treatment using new processing sets for triple-dose units. Transfusion 2018; 58:2942-2951. [PMID: 30362131 DOI: 10.1111/trf.14909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The INTERCEPT Blood System (IBS) for platelets (PLTs) uses a combination of psoralen and ultraviolet-A light to inactivate pathogens that may contaminate PLT concentrates (PCs). However, no data are available on the quality of IBS-treated PLTs from different apheresis and buffy-coat PC preparation platforms using the new triple storage (TS) set. STUDY DESIGN AND METHODS The objective of this study was to evaluate the TS set on three different preparation platforms compared with the large-volume (LV) set, as control. PLT in vitro metabolic and activation parameters were studied over 7 days. RESULTS Several statistical differences are observed between the two sets, particularly for pH, oxygen pressure (pO2 ), carbonic gaz pressure (pCO2 ), and bicarbonate. The three different preparation techniques influence PLT parameters, and the difference is statistically significant for all the studied parameters, except for pCO2 . The TS set has the advantage of shorter compound adsorption device time, higher PLT recoveries, and less PLT activation. CONCLUSION Results from the measured metabolic parameters and PLT variables obtained from PCs treated by LV and TS sets indicated good PLT function preservation up to 7 days of storage. The in vitro assessment results demonstrated acceptable PLT function for transfusion.
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Affiliation(s)
- Anaïs Lotens
- Service du Sang, Belgian Red Cross, Namur, Belgium
| | | | | | | | - Fabrice Cognasse
- Etablissement Français du Sang, Saint-Etienne, France.,Université de Lyon, GIMAP-EA3064, Saint-Etienne, France
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Cicchetti A, Coretti S, Sacco F, Rebulla P, Fiore A, Rumi F, Di Bidino R, Urbina LI, Refolo P, Sacchini D, Spagnolo AG, Midolo E, Marano G, Farina B, Pati I, Veropalumbo E, Pupella S, Liumbruno GM. Budget impact of implementing platelet pathogen reduction into the Italian blood transfusion system. Blood Transfus 2018; 16:483-9. [PMID: 30201081 DOI: 10.2450/2018.0115-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/26/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite improvements in blood donor selection and screening procedures, transfusion recipients can still develop complications related to infections by known and emerging pathogens. Pathogen reduction technologies (PRT) have been developed to reduce such risks. The present study, developed whithin a wider health technology assessment (HTA) process, was undertaken to estimate the costs of the continuing increase in the use of platelet PRT in Italy. MATERIALS AND METHODS A multidisciplinary team was established to perform the HTA and conduct a budget impact analysis. Quantitative data on platelet use were derived from the 2015 national blood transfusion report and from the Italian Platelets Transfusion Assessment Study (IPTAS). The current national fee of 60 Euro per platelet PRT procedure was used to quantify the costs to the Italian National Health Service (INHS). The analysis adopts a 3-year time-frame. In order to identify the impact on budget we compared a scenario representing an increased use of PRT platelets over time with a control scenario in which standard platelets are used. RESULTS Progressive implementation of PRT for 20%, 40% and 66% of annual adult platelet doses could generate an increase in annual costs for the INHS amounting to approximately 7, 14 and 23 million Euros, respectively. Use of kits and devices suitable for the treatment of multiple adult platelet doses in one PRT procedure could lower costs. DISCUSSION In order to fully evaluate the societal perspective of implementing platelet PRT, the increase in costs must be balanced against the expected benefits (prevention of transfusion-transmissible infections, white cell inactivation, extension of platelet storage, discontinuation of pathogen detection testing). Further studies based on actual numbers of platelet transfusion complications and their societal cost at a local level are needed to see the full cost to benefit ratio of platelet PRT implementation in Italy, and to promote equal treatment for all citizens.
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Jimenez-Marco T, Garcia-Recio M, Girona-Llobera E. Our experience in riboflavin and ultraviolet light pathogen reduction technology for platelets: from platelet production to patient care. Transfusion 2018; 58:1881-1889. [DOI: 10.1111/trf.14797] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/19/2018] [Accepted: 03/19/2018] [Indexed: 12/18/2022]
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Abstract
Since the late sixties, platelet concentrates are transfused to patients presenting with severe thrombocytopenia, platelet function defects, injuries, or undergoing surgery, to prevent the risk of bleeding or to treat actual hemorrhage. Current practices differ according to the country or even in different hospitals and teams. Although crucial advances have been made during the last decades, questions and debates still arise about the right doses to transfuse, the use of prophylactic or therapeutic strategies, the nature and quality of PC, the storage conditions, the monitoring of transfusion efficacy and the microbiological and immunological safety of platelet transfusion. Finally, new challenges are emerging with potential new platelet products, including cold stored or in vitro produced platelets. The most debated of these points are reviewed.
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Affiliation(s)
- C Humbrecht
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France.
| | - D Kientz
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France
| | - C Gachet
- Établissement français du sang grand est, 85-87, boulevard Lobau, 54064 Nancy cedex, France.
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van der Meer PF, Ypma PF, van Geloven N, van Hilten JA, van Wordragen-vlaswinkel RJ, Eissen O, Zwaginga JJ, Trus M, Beckers EAM, te Boekhorst P, Tinmouth A, Lin Y, Hsia C, Lee D, Norris PJ, Goodrich RP, Brand A, Hervig T, Heddle NM, van der Bom JG, Kerkhoffs JH. Hemostatic efficacy of pathogen-inactivated vs untreated platelets: a randomized controlled trial. Blood 2018; 132:223-31. [DOI: 10.1182/blood-2018-02-831289] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Key Points
Pathogen-inactivated platelets were noninferior in preventing bleeding only in intention-to-treat analysis. In contrast to animal models, alloimmunization could not be prevented when using pathogen-inactivated platelets.
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Saris A, Peyron I, van der Meer PF, Stuge TB, Zwaginga JJ, van Ham SM, ten Brinke A. Storage-Induced Platelet Apoptosis Is a Potential Risk Factor for Alloimmunization Upon Platelet Transfusion. Front Immunol 2018; 9:1251. [PMID: 29951051 PMCID: PMC6008548 DOI: 10.3389/fimmu.2018.01251] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/18/2018] [Indexed: 12/21/2022] Open
Abstract
Platelet transfusion can elicit alloimmune responses leading to alloantibody formation against donor-specific polymorphic residues, ultimately resulting in platelet transfusion refractoriness. Universal leukoreduction significantly reduced the frequency of alloimmunization after platelet transfusion, thereby showing the importance of white blood cells (WBCs) in inducing this alloresponse. It is, however, unknown if the residual risk for alloimmunization is caused by WBCs remaining after leukoreduction or if alloimmunization can be induced by platelets themselves. This study investigated the capacity of platelets to induce alloimmunization and identified potential product-related risk factors for alloimmunization. First, internalization of allogeneic platelets by dendritic cells (DCs) was demonstrated by confocal microscopy. Second, after internalization, presentation of platelet-derived peptides was shown by mass spectrometry analysis of human leukocytes antigen (HLA)-DR eluted peptides. Third, platelet-loaded DCs induced platelet-specific CD4 T cell responses. Altogether, this indicates a platelet-specific ability to induce alloimmunization. Therefore, factors enhancing platelet internalization may be identified as risk factor for alloimmunization by platelet concentrates. To investigate if storage of platelets is such a risk factor, internalization of stored platelets was compared with fresh platelets and showed enhanced internalization of stored platelets. Storage-induced apoptosis and accompanied phosphatidylserine exposure seemed to be instrumental for this. Indeed, DCs pre-incubated with apoptotic platelets induced the strongest IFN-γ production by CD4 T cells compared with pre-incubation with untreated or activated platelets. In conclusion, this study shows the capacity of platelets to induce platelet-specific alloimmune responses. Furthermore, storage-induced apoptosis of platelets is identified as potential risk factor for alloimmunization after platelet transfusions.
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Affiliation(s)
- Anno Saris
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Ivan Peyron
- Department of Plasma Proteins, Sanquin Research, Amsterdam, Netherlands
| | | | - Tor B. Stuge
- Immunology Research Group, Department of Medical Biology, University of Tromsø – The Arctic University of Norway, Tromso, Norway
| | - Jaap Jan Zwaginga
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - S. Marieke van Ham
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
- Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Anja ten Brinke
- Department of Immunopathology, Sanquin Research, Amsterdam, Netherlands
- Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
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Goodrich RP, Segatchian J. Special considerations for the use of pathogen reduced blood components in pediatric patients: An overview. Transfus Apher Sci 2018; 57:374-377. [DOI: 10.1016/j.transci.2018.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Garban F, Guyard A, Labussière H, Bulabois CE, Marchand T, Mounier C, Caillot D, Bay JO, Coiteux V, Schmidt-Tanguy A, Le Niger C, Robin C, Ladaique P, Lapusan S, Deconinck E, Rolland C, Foote AM, François A, Jacquot C, Tardivel R, Tiberghien P, Bosson JL. Comparison of the Hemostatic Efficacy of Pathogen-Reduced Platelets vs Untreated Platelets in Patients With Thrombocytopenia and Malignant Hematologic Diseases: A Randomized Clinical Trial. JAMA Oncol 2018; 4:468-475. [PMID: 29392283 PMCID: PMC5885167 DOI: 10.1001/jamaoncol.2017.5123] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/09/2017] [Indexed: 01/10/2023]
Abstract
IMPORTANCE Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. OBJECTIVE To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. DESIGN, SETTING, AND PARTICIPANTS The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals. Clinical signs of bleeding were assessed daily until the end of aplasia, transfer to another department, need for a specific platelet product, or 30 days after enrollment. Consecutive adult patients with bone marrow aplasia, expected hospital stay of more than 10 days, and expected need of platelet transfusions were included. INTERVENTIONS At least 1 transfusion of platelets in additive solution with amotosalen-UV-A treatment, in plasma, or in additive solution. MAIN OUTCOMES AND MEASURES The proportion of patients with grade 2 or higher bleeding as defined by World Health Organization criteria. RESULTS Among 790 evaluable patients (mean [SD] age, 55 [13.4] years; 458 men [58.0%]), the primary end point was observed in 126 receiving pathogen-reduced platelets in additive solution (47.9%; 95% CI, 41.9%-54.0%), 114 receiving platelets in plasma (43.5%; 95% CI, 37.5%-49.5%), and 120 receiving platelets in additive solution (45.3%; 95% CI, 39.3%-51.3%). With a per-protocol population with a prespecified margin of 12.5%, noninferiority was not achieved when pathogen-reduced platelets in additive solution were compared with platelets in plasma (4.4%; 95% CI, -4.1% to 12.9%) but was achieved when the pathogen-reduced platelets were compared with platelets in additive solution (2.6%; 95% CI, -5.9% to 11.1%). The proportion of patients with grade 3 or 4 bleeding was not different among treatment arms. CONCLUSIONS AND RELEVANCE Although the hemostatic efficacy of pathogen-reduced platelets in thrombopenic patients with hematologic malignancies was noninferior to platelets in additive solution, such noninferiority was not achieved when comparing pathogen-reduced platelets with platelets in plasma. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01789762.
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Affiliation(s)
- Frédéric Garban
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Service d’Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
- Etablissement Français du Sang, Grenoble, France
| | - Audrey Guyard
- Centre d’Investigation Clinique 1406–Innovation Technologique, Institut national de la santé et de la recherche médicale, Grenoble, France
- Service de Biostatistiques, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Helene Labussière
- Service d’Hématologie, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Claude-Eric Bulabois
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Service d’Hématologie, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Tony Marchand
- Service d’Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Christiane Mounier
- Service d’Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Denis Caillot
- Service d’Hématologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Jacques-Olivier Bay
- Service d’Hématologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Coiteux
- Service d’Hématologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Aline Schmidt-Tanguy
- Service d’Hématologie, Centre Hospitalier Universitaire d’Angers, Angers, France
| | - Catherine Le Niger
- Service d’Hématologie, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Christine Robin
- Service d’Hématologie, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France
| | - Patrick Ladaique
- Service d’Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Simona Lapusan
- Service d’Hématologie, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eric Deconinck
- Service d’Hématologie, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Carole Rolland
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
| | - Alison M. Foote
- Cellule Publication, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
| | - Anne François
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - Chantal Jacquot
- Etablissement Français du Sang, La Plaine Saint-Denis, France
| | - René Tardivel
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- Etablissement Français du Sang, Rennes, France
| | - Pierre Tiberghien
- Etablissement Français du Sang, La Plaine Saint-Denis, France
- Unité mixte de recherche 1098, Institut national de la santé et de la recherche médicale, Université de Franche-Comté, Etablissement Français du Sang, Besançon, France
| | - Jean-Luc Bosson
- University Grenoble Alpes, Centre National de Recherche Scientifique, Techniques de l'Ingénierie Médicale et de la Complexité–Institut Mathématiques Appliquées de Grenoble 38000, Grenoble, France
- Centre d’Investigation Clinique 1406–Innovation Technologique, Institut national de la santé et de la recherche médicale, Grenoble, France
- Service de Biostatistiques, Centre Hospitalier Universitaire de Grenoble Alpes, Grenoble, France
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Cushing MM, Kelley J, Klapper E, Friedman DF, Goel R, Heddle NM, Hopkins CK, Karp JK, Pagano MB, Perumbeti A, Ramsey G, Roback JD, Schwartz J, Shaz BH, Spinella PC, Cohn CS, Cohn CS, Cushing MM, Kelley J, Klapper E. Critical developments of 2017: a review of the literature from selected topics in transfusion. A committee report from the AABB Clinical Transfusion Medicine Committee. Transfusion 2018. [PMID: 29520794 DOI: 10.1111/trf.14520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The AABB compiles an annual synopsis of the published literature covering important developments in the field of Transfusion Medicine. For the first time, an abridged version of this work is being made available in TRANSFUSION, with the full-length report available as an Appendix S1 (available as supporting information in the online version of this paper). STUDY DESIGN AND METHODS Papers published in 2016 and early 2017 are included, as well as earlier papers cited for background. Although this synopsis is comprehensive, it is not exhaustive, and some papers may have been excluded or missed. RESULTS The following topics are covered: duration of red blood cell storage and clinical outcomes, blood donor characteristics and patient outcomes, reversal of bleeding in hemophilia and for patients on direct oral anticoagulants, transfusion approach to hemorrhagic shock, pathogen inactivation, pediatric transfusion medicine, therapeutic apheresis, and extracorporeal support. CONCLUSION This synopsis may be a useful educational tool.
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Affiliation(s)
| | - James Kelley
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - David F Friedman
- Blood Bank and Transfusion Medicine Department, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruchika Goel
- Department of Pathology, Weill Cornell Medicine, New York, New York
| | - Nancy M Heddle
- McMaster Center for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | | | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Monica B Pagano
- Transfusion Medicine Division, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Glenn Ramsey
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center and the New York-Presbyterian Hospital
| | | | - Philip C Spinella
- Department of Pediatrics, Division of Pediatric Critical Care, Washington University School of Medicine, St Louis, Missouri
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Claudia S Cohn
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | | | - James Kelley
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ellen Klapper
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California
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47
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Devine DV. Implementation of pathogen inactivation technology: how to make the best decisions? Transfusion 2018; 57:1109-1111. [PMID: 28425602 DOI: 10.1111/trf.14117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Dana V Devine
- Canadian Blood Services, University of British Columbia, Vancouver, BC, Canada.,Centre for Blood Research and the Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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48
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Norris PJ, Kaidarova Z, Maiorana E, Milani S, Lebedeva M, Busch MP, Custer B, Rebulla P. Ultraviolet light-based pathogen inactivation and alloimmunization after platelet transfusion: results from a randomized trial. Transfusion 2018; 58:1210-1217. [PMID: 29473173 DOI: 10.1111/trf.14534] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/03/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The current study explored whether pathogen-reduction treatment of platelet components before transfusion would decrease the risk of alloimmunization. STUDY DESIGN AND METHODS Study participants were patients with hematologic cancer who were included in two parallel, randomized clinical trials testing pathogen-reduction treatment versus conventional platelets using the Mirasol or Intercept pathogen-reduction systems. Patients who had a baseline, pretransfusion sample and a follow-up, posttransfusion sample were included in the study (n = 179 patients in each study arm). Human leukocyte antigen antibody levels were determined using a commercial multianalyte, bead-based assay. RESULTS The rate of human leukocyte antigen Class I alloimmunization at the clinical sites in recipients of conventional platelets was low at the highest assay cutoff (range, 1.2%-5.9%). Consistent with prior studies, human leukocyte antigen antibodies were first detected from 3 to 35 days after transfusion. There were no statistically significant differences between alloimmunization rates in patients who received pathogen-reduction treatment versus conventional platelet transfusions. Although he difference was not statistically significant, the effect size for protection from alloimmunization was greatest for high-level human leukocyte antigen Class I antibodies (approximately threefold) in the Intercept-treated patients compared with those who received conventional platelets. In the Mirasol study, only two patients and one patient in the control group developed medium-level or high-level antibodies, respectively, so it was impossible to determine an effect size for potential protection. CONCLUSIONS The current study was not sufficiently powered to determine whether pathogen-reduction treatment provides protection from human leukocyte antigen alloimmunization in platelet transfusion recipients. The data presented will be useful in the design of future trials and endpoints powered to detect a protective effect.
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Affiliation(s)
- Philip J Norris
- Blood Systems Research Institute.,Department of Laboratory Medicine, University of California-San Francisco.,Department of Medicine, University of California-San Francisco, San Francisco, California
| | | | | | - Silvano Milani
- Laboratory of Medical Statistics and Biometry, Department of Clinical Sciences and Community Health, University of Milan
| | | | - Michael P Busch
- Blood Systems Research Institute.,Department of Laboratory Medicine, University of California-San Francisco
| | - Brian Custer
- Blood Systems Research Institute.,Department of Laboratory Medicine, University of California-San Francisco
| | - Paolo Rebulla
- Department of Regenerative Medicine, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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49
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Waters L, Cameron M, Padula MP, Marks DC, Johnson L. Refrigeration, cryopreservation and pathogen inactivation: an updated perspective on platelet storage conditions. Vox Sang 2018; 113:317-328. [PMID: 29441601 DOI: 10.1111/vox.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 01/15/2018] [Indexed: 01/08/2023]
Abstract
Conventional storage of platelet concentrates limits their shelf life to between 5 and 7 days due to the risk of bacterial proliferation and the development of the platelet storage lesion. Cold storage and cryopreservation of platelets may facilitate extension of the shelf life to weeks and years, and may also provide the benefit of being more haemostatically effective than conventionally stored platelets. Further, treatment of platelet concentrates with pathogen inactivation systems reduces bacterial contamination and provides a safeguard against the risk of emerging and re-emerging pathogens. While each of these alternative storage techniques is gaining traction individually, little work has been done to examine the effect of combining treatments in an effort to further improve product safety and minimize wastage. This review aims to discuss the benefits of alternative storage techniques and how they may be combined to alleviate the problems associated with conventional platelet storage.
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Affiliation(s)
- L Waters
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M Cameron
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia.,School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - M P Padula
- School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - D C Marks
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
| | - L Johnson
- Research & Development, Australian Red Cross Blood Service, Alexandria, NSW, Australia
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50
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Affiliation(s)
- Paul M Ness
- Johns Hopkins University School of Medicine, Baltimore, MD
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