Background/Case Studies: Many transfusion services have replaced their inventories of plasma-suspended platelets (PS platelets) with platelets in platelet additive solution (PAS platelets). This shift has largely been driven by expansion of pathogen reduction, desire to avoid adverse transfusion reactions and greater flexibility to issue ABO incompatible units. However, studies have suggested that recipients of PAS platelets experience inferior increments when compared to PS platelets. In this study, we evaluated responses to PAS and PS platelets in hospitalized patients.
Study
Design/Methods: This retrospective study was conducted at the University of Michigan. Eligible subjects received at least one single-donor PS and one PAS platelet unit within the same hospital stay. Subjects requiring split platelet units, or who received the transfusion in locations other than a medical-surgical floor were excluded. Recipients of PS platelets after January 2022, when the inventory transitioned to predominantly pathogen reduced PAS platelets, were identified from the laboratory information system and considered for inclusion. Eligible subject electronic records were reviewed manually to collect basic demographics, platelet transfusion dates, 1-hour post-transfusion platelet counts, and other factors contributing to platelet refractoriness. Corrected count increments (CCIs) were calculated for all available platelet transfusions, including HLA- and crossmatched (HLA/XM) platelets in PAS. Descriptive statistics were performed in Microsoft Excel for each platelet type received. Mean CCIs for all platelet types were compared using paired student’s t tests. A p-value of < 0.05 was considered significant.
Results/Findings: Thirty-nine subjects met inclusion criteria. Most subjects (92%) were platelet refractory with CCIs < 5000 after 2 subsequent transfusions at some point during their hospitalization. Factors contributing to refractoriness included sepsis (64%), splenomegaly (46%), active bleeding (41%), and post-bone marrow transplant status (33%). PS platelets produced greater mean increments than random donor PAS platelets (5460.4 [SD 3637] vs. 2836 [SD 2031], p = 0.0001) or HLA/XM platelets (2285 [SD 1021], p = 0.019) (Figure 1). After favorable responses, six subjects were assigned to receive PS platelets exclusively. No transfusion-related adverse effects were associated with PS platelet transfusions.
Conclusions: PS platelets produced superior responses to PAS platelets in a cohort of hospitalized patients at a single center. Based on these findings, future studies could evaluate how the transition to predominantly single-donor PAS platelets at large academic centers who care for complex, high acuity patients have affected overall platelet use, inventory costs, and patient safety.
