Storage and transfusion of platelets : in vitro and in vivo studies in healthy volunteers and in allogeneic hemapoetic progenitor cell transplant recipents
Author: Diedrich, Beatrice
Date: 2009-04-03
Location: Hörsalen, 1tr ned, NOVUM, Karolinska Universitetssjukhuset, Huddinge
Time: 10.00
Department: Institutionen för laboratoriemedicin / Department of Laboratory Medicine
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thesis.pdf (256.1Kb)
Abstract
Early studies in the 1960´s showed that platelet (PLT) transfusions
significantly reduced the incidence of fatal hemorrhages. Together with
the advances in the hematology and transplantation field, easily
accessible PLTs for transfusion use have resulted in a rapid increase of
PLT utilization and a change from therapeutic-i.e., treatment of clinical
bleeding- to prophylactic PLT transfusions, despite limited clinical
evidence regarding whether a prophylactic PLT transfusion strategy
results in a lower morbidity or mortality compared with transfusing
patients with early signs of bleeding. About 2 million PLTs are
transfused in the United States, 2.9 million in Europe and 40 000 in
Sweden with a roughly tenfold increase since 1984. In a 1991 survey in
the United States, more than 70% of hospitals reported transfusing PLTs
primarily for prophylaxis. Continued increase in demand may result in
problems with shortages and difficulties to comply with orders.
Several in vitro studies have shown satisfactory quality results for platelets stored for 7 days and even longer. Storage has been limited to 5 days because of the risk of bacterial contamination, with subsequent bacterial increase during storage at room temperature. Provided that contaminating bacteria can be effectively detected or put out of action in platelets, prolonged storage represents one possibility to obtain improved availability, logistical management and decreased outdating.
The overall aim of this thesis was to assess the quality of platelets after prolonged storage up to 7 days and to evaluate the consequences of lowering the platelet transfusion trigger for prophylactic transfusion, representing two possible approaches suggested to have impact on the platelet accessibility.
In paper I, we showed that a prophylactic platelet transfusion trigger level of 10 instead of 30 x109 platelets/L for allogeneic HPCT recipients considerably reduced the number of PLT transfusions without increasing the incidence of hemorrhagic events. In paper II, recovery and survival in healthy volunteers of PLTs stored for 7 days decreased, but met the suggested criteria. Analyzed in vitro parameters showed acceptable results. Addition of potassium and magnesium to the storage medium indicated higher quality in vitro but this could not be verified by in vivo recovery and survival (paper III). In paper IV, when comparing transfusion in allogeneic HPCT recipients of PLTs stored for 6-7 days vs 1-5 days, a significant lower platelet increment (CCI) and shorter interval between transfusions was noticed with prolonged storage.
To have sufficient PLTs of excellent quality in stock at any given time to provide to patients in great need represents a difficult challenge to transfusion services. If prolonged storage results in decreased time between the transfusion and more PLTs are transfused in general the result might not be what was aimed at. In that case it might be wiser to question the need of prophylactic transfusion. Lately it has been proposed that patient selection may be the key to the safety of therapeutic only based platelet transfusion strategy. To conclude, there is a growing need of further randomized, controlled clinical trials to establish the therapeutic approaches that maximizes the quality of patient care in different patient categories while minimizing expenses to transfusion services and the health care system to be able to ensure an adequate PLT supply when really needed.
Several in vitro studies have shown satisfactory quality results for platelets stored for 7 days and even longer. Storage has been limited to 5 days because of the risk of bacterial contamination, with subsequent bacterial increase during storage at room temperature. Provided that contaminating bacteria can be effectively detected or put out of action in platelets, prolonged storage represents one possibility to obtain improved availability, logistical management and decreased outdating.
The overall aim of this thesis was to assess the quality of platelets after prolonged storage up to 7 days and to evaluate the consequences of lowering the platelet transfusion trigger for prophylactic transfusion, representing two possible approaches suggested to have impact on the platelet accessibility.
In paper I, we showed that a prophylactic platelet transfusion trigger level of 10 instead of 30 x109 platelets/L for allogeneic HPCT recipients considerably reduced the number of PLT transfusions without increasing the incidence of hemorrhagic events. In paper II, recovery and survival in healthy volunteers of PLTs stored for 7 days decreased, but met the suggested criteria. Analyzed in vitro parameters showed acceptable results. Addition of potassium and magnesium to the storage medium indicated higher quality in vitro but this could not be verified by in vivo recovery and survival (paper III). In paper IV, when comparing transfusion in allogeneic HPCT recipients of PLTs stored for 6-7 days vs 1-5 days, a significant lower platelet increment (CCI) and shorter interval between transfusions was noticed with prolonged storage.
To have sufficient PLTs of excellent quality in stock at any given time to provide to patients in great need represents a difficult challenge to transfusion services. If prolonged storage results in decreased time between the transfusion and more PLTs are transfused in general the result might not be what was aimed at. In that case it might be wiser to question the need of prophylactic transfusion. Lately it has been proposed that patient selection may be the key to the safety of therapeutic only based platelet transfusion strategy. To conclude, there is a growing need of further randomized, controlled clinical trials to establish the therapeutic approaches that maximizes the quality of patient care in different patient categories while minimizing expenses to transfusion services and the health care system to be able to ensure an adequate PLT supply when really needed.
List of papers:
I. Diedrich B, Remberger M, Shanwell A, Svahn BM, Ringden O (2005). "A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 10(9) per L versus 30 x 10(9) per L in allogeneic hematopoietic progenitor cell transplant recipients." Transfusion 45(7): 1064-72
Pubmed
II. Shanwell A, Diedrich B, Falker C, Jansson B, Sandgren P, Sundkvist L, Svensson L, Vesterinen M, Gulliksson H (2006). "Paired in vitro and in vivo comparison of apheresis platelet concentrates stored in platelet additive solution for 1 versus 7 days." Transfusion 46(6): 973-9
Pubmed
III. Diedrich B, Sandgren P, Jansson B, Gulliksson H, Svensson L, Shanwell A (2008). "In vitro and in vivo effects of potassium and magnesium on storage up to 7 days of apheresis platelet concentrates in platelet additive solution." Vox Sang 94(2): 96-102. Epub 2007 Nov 22
Pubmed
IV. Diedrich B, Ringdén O, Watz E, Shanwell A (2009). "A randomized study in allogeneic hematopoetic progenitor cell transplant recipients of prophylactic transfusion of buffy coat platelets stored for 1-5 versus 6-7 days in platelet additive solution." Vox Sang (Submitted)
I. Diedrich B, Remberger M, Shanwell A, Svahn BM, Ringden O (2005). "A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 10(9) per L versus 30 x 10(9) per L in allogeneic hematopoietic progenitor cell transplant recipients." Transfusion 45(7): 1064-72
Pubmed
II. Shanwell A, Diedrich B, Falker C, Jansson B, Sandgren P, Sundkvist L, Svensson L, Vesterinen M, Gulliksson H (2006). "Paired in vitro and in vivo comparison of apheresis platelet concentrates stored in platelet additive solution for 1 versus 7 days." Transfusion 46(6): 973-9
Pubmed
III. Diedrich B, Sandgren P, Jansson B, Gulliksson H, Svensson L, Shanwell A (2008). "In vitro and in vivo effects of potassium and magnesium on storage up to 7 days of apheresis platelet concentrates in platelet additive solution." Vox Sang 94(2): 96-102. Epub 2007 Nov 22
Pubmed
IV. Diedrich B, Ringdén O, Watz E, Shanwell A (2009). "A randomized study in allogeneic hematopoetic progenitor cell transplant recipients of prophylactic transfusion of buffy coat platelets stored for 1-5 versus 6-7 days in platelet additive solution." Vox Sang (Submitted)
Issue date: 2009-03-13
Rights:
Publication year: 2009
ISBN: 978-91-7409-280-6
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