Platelet transfusions in patients with a hematological malignancy : improving the chain

Abstract

The majority of platelet transfusions are given to

patients with a hematological malignancy to prevent or treat bleeding

complications. The adhered transfusion trigger for patients with an increased

risk of bleeding varies among hematologists. Although almost 20.000 donors are HLA typed in the Netherlands, adequate transfusion support cannot be guaranteed for all immunized patients, especially not for patients from a non-Caucasian background. From a clinical perspective, major hemorrhage is the most relevant outcome to measure effectiveness of platelet transfusions. We developed a model consisting of drop in hemoglobin, transfusion support, and CT-brain to enable the identification of major hemorrhage among leukemic patients in routinely recorded data. In the Netherlands, the standard platelet concentrate is derived from buffy coats and resuspended in plasma or platelet additive solution (PAS) and can be stored for seven days. Storage has a negative effect on safety and efficacy of platelet transfusions. Using routinely collected health care data, we demonstrated a lower risk of a positive blood culture after transfusion of platelet concentrates stored for five to seven days. Using the database of TRIP, we showed an increased risk of transfusion transmitted bacterial infections for platelet concentrates stored in PAS compared to those stored in plasma.