Evaluation of Platelet Transfusions Practice: Results of at a Tertiary Healthcare Center in Turkey

Year 2022, Volume: 19 Issue: 1, 105 - 109, 28.04.2022

Ahmet Şeyhanlı , Çağatay Çakır , Fatih Demirkan , Hayri Özsan , İnci Alacacıoğlu

https://doi.org/10.35440/hutfd.1066407

Abstract

Background: Platelet transfusion is an effective method used to prevent and treat bleeding in thrombocyto-penic patients. The impact of platelet transfusion without respecting the ABO compatibility on platelet transfusion refractoriness is debated. We aimed to evaluate platelet transfusions practice at our tertiary care hospital.
Materials and Methods: We analyzed 849 hematology-oncology patients who underwent platelet transfu-sion at Dokuz Eylül University Hospital between January 2014 and December 2020. Case under the age of 18 were excluded from the study. We retrospectively assessed the demographic data of selected cases, the types of transfusion products employed, and patients’ laboratory parameters.
Results: Hematology-oncology patients accounted for 44.6% (n=849) of the transfusions. Much of the remainder is used in the emergency department 11.7% (n=224) and intensive care 6.8% (n=131). Eight hundred and forty-nine hemato-oncological patients were retrospectively identified between 2014 and 2020. The median age was 60 (18–91) years, with 44.6% women. ABO-identical platelet transfusions were 93.6%. Eighty-one percent of platelets were transfused to patients with counts < 25 × 10^6 µL. Post transfu-sion the next day, platelet count increment <10 × 10^6 µL was 31.6%, 37.5%, 30.0% for ABO compatible, ABO major incompatible, and ABO minor incompatible, respectively.
Conclusions: We conclude that platelet transfusions should always be made to only ABO identical platelets whenever possible. As with every blood product transfusion, comprehensive and practical national policies should be developed based on international guidelines for causing minimum side effects and maximum efficacy for platelet transfusion.

Keywords

Platelet transfusion, ABO blood group, Refractoriness, ABO compatibility, Platelet transfusion, ABO blood group, Refractoriness, ABO compatibility

Trombosit Transfüzyonu Uygulamasının Değerlendirilmesi: Türkiye'de Üçüncü Basamak Sağlık Merkezi Sonuçları

Abstract

Amaç: Trombosit transfüzyonu trombositopenik hastalarda kanamayı önlemek ve tedavi etmek için standart ve etkili bir tedavidir. ABO uyumluluğu gözetilmeksizin trombosit transfüzyonunun trombosit transfüzyon refrakterliği üzerindeki etkisi tartışılmalıdır. Üçüncü basamak hastanemizde ABO ile uyumlu olan veya olmayan trombosit transfüzyonu uygulamamızı değerlendirmeyi amaçladık.
Gereç ve Yöntem: Türkiye'deki 9 Eylül Üniversite Hastanesinde Ocak 2014'ten Aralık 2020'ye kadar 849 trombosit transfüze hematoloji-onkoloji hastasını analiz ettik. 18 yaş altı olgular çalışma dışı bırakıldı. Seçilmiş vakaların demografik verilerini, kullanılan transfüzyon ürünlerinin uygunlukları ve hastaların laboratuvar parametrelerini geriye dönük olarak değerlendirdik.
Bulgular: Transfüzyon yapılan hastaların %44,6'sını hematoloji-onkoloji hastaları oluşturdu. Transfüzyon uygulamalarının %11’i acil serviste ve %6.8’sı yoğun bakım ünitelerinde uygulandı. 2014 ve 2020 yılları arasında sekiz yüz kırk dokuz hemato-onkolojik hasta geriye dönük olarak tanımlandı. Ortanca yaş 60 (18–91) idi ve %44.6'sı kadındı. ABO-tam uyumlu trombosit transfüzyonları %93,6 idi. Trombositlerin yüzde seksen biri, sayısı < 25 × 10^6 µL olan hastalara transfüze edildi. Transfüzyondan bir sonraki gün, trombosit sayısı artışı <10 × 10^6 µL, sırasıyla ABO uyumlu, ABO majör uyumsuz ve ABO minör uyumsuz için sırasıyla %31.6, %37.5, %30.0 idi.
Sonuç: Trombosit transfüzyonlarının mümkün olduğunda her zaman sadece ABO ile özdeş trombositlere yapılması gerektiği sonucuna vardık. Her kan ürünü transfüzyonunda olduğu gibi, trombosit transfüzyonunda da minimum yan etki ve maksimum etkinliğe neden olmak için uluslararası kılavuzlara dayalı kapsamlı ve pratik ulusal politikalar geliştirilmelidir.
Anahtar Kelimeler: Trombosit transfüzyonu, ABO kan grubu, refrakterlik, ABO uyumluluğu

Keywords

Platelet transfusion, ABO blood group, refractoriness, ABO compatibility, Platelet transfusion, ABO blood group, refractoriness, ABO compatibility

References

• 1. Cameron B, Rock G, Olberg B, Neurath D. Evaluation of platelet transfusion triggers in a tertiary‐care hospital. Transfusion. 2007;47(2):206-11.
• 2. Estcourt L, Birchall J, Allard S, et al. Guidelines for the use of platelet transfusions. Br J Haematol. 2016;176(3).
• 3. Andreu G, Vasse J, Herve F, Tardivel R, et al. Introduction of platelet additive solutions in transfusion practice. Advantages, disadvantages and benefit for patients. Transfusion clinique et biologique: journal de la Societe francaise de transfusion sanguine. 2007;14(1):100-6.
• 4. Petraszko T, Zeller M. Professional Education.
• 5. Triulzi DJ, Assmann SF, Strauss RG, et al. The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia. Blood. 2012;119(23):5553-62.
• 6. Ogasawara K, Ueki J, Takenaka M, Furihata K. Study on the expression of ABH antigens on platelets. 1993.
• 7. Aster RH. Effect of anticoagulant and ABO incompatibility on recovery of transfused human platelets. Blood. 1965;26(6):732-43.
• 8. Pfisterer H, Stich W. ABO Rh blood groups and platelet transfusion. Blut. 1968;17(1):1-5.
• 9. Kelton J, Hamid C, Aker S, Blajchman M. The amount of blood group A substance on platelets is proportional to the. Blood. 1982;59(5).
• 10. Curtis BR, Edwards JT, Hessner MJ, et al. Blood group A and B antigens are strongly expressed on platelets of some individuals. Blood, The Journal of the American Society of Hematology. 2000;96(4):1574-81.
• 11. Lawrence JB, Yomtovian RA, Hammons T, et al. Lowering the prophylactic platelet transfusion threshold: a prospective analysis. Leuk Lymphoma. 2001;41(1-2):67-76.
• 12. Rebulla P, Finazzi G, Marangoni F, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med. 1997;337(26):1870-5.
• 13. Wandt H, Frank M, Ehninger G, et al. Safety and cost effectiveness of a 10× 109/L trigger for prophylactic platelet transfusions compared with the traditional 20× 109/L trigger: a prospective comparative trial in 105 patients with acute myeloid leukemia. Blood, The Journal of the American Society of Hematology. 1998;91(10):3601-6.
• 14. Blumberg N, Heal JM, Phillips GL. Platelet transfusions: trigger, dose, benefits, and risks. F1000 Med Rep. 2010;2.
• 15. Ness PM, Campbell-Lee SA. Single donor versus pooled random donor platelet concentrates. Curr Opin Hematol. 2001;8(6):392-6.
• 16. Whitaker B, Green J, King M. The 2007 Nationwide Blood Collection and Utilization Survey Report. Washington DC, Department of Health and Human Services. 2010.
• 17. Storch EK, Custer BS, Jacobs MR, et al. Review of current transfusion therapy and blood banking practices. Blood Rev. 2019;38:100593.
• 18. Hod E, Schwartz J. Platelet transfusion refractoriness. Br J Haematol. 2008;142(3):348-60.
• 19. Carr R, Hutton JL, Jenkins JA, et al. Transfusion of ABO‐mismatched platelets leads to early platelet refractoriness. Br J Haematol. 1990;75(3):408-13.
• 20. Kerkhoffs JLH, Eikenboom JC, Van De Watering LM, et al. The clinical impact of platelet refractoriness: correlation with bleeding and survival. Transfusion. 2008;48(9):1959-65.
• 21. Jiménez TM, Patel SB, Pineda AA, et al. Factors that influence platelet recovery after transfusion: resolving donor quality from ABO compatibility. Transfusion. 2003;43(3):328-34.
• 22. Heal JM, Kenmotsu N, Rowe JM, Blumberg N. A possible survival advantage in adults with acute leukemia receiving ABO‐identical platelet transfusions. Am J Hematol. 1994;45(2):189-90.
• 23. Solves P, Carpio N, Balaguer A, et al. Transfusion of ABO non-identical platelets does not influence the clinical outcome of patients undergoing autologous hematopoietic stem cell transplantation. Blood Transfusion. 2015;13(3):411.
• 24. Molnar R, Johnson R, Sweat L, Geiger T. Absence of D alloimmunization in D–pediatric oncology patients receiving D‐incompatible single‐donor platelets. Transfusion. 2002;42(2):177-82.
• 25. Villalba A, Santiago M, Freiria C, et al. Anti-D alloimmunization after RhD-positive platelet transfusion in RhD-negative women under 55 years diagnosed with acute leukemia: results of a retrospective study. Transfusion Medicine and Hemotherapy. 2018;45(3):162-6.
• 26. O'Brien KL, Haspel RL, Uhl L. Anti‐D alloimmunization after D‐incompatible platelet transfusions: a 14‐year single‐institution retrospective review. Transfusion. 2014;54(3):650-4.