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Comparative assessment of prophylactic transfusions of platelet concentrates obtained by the PRP or buffy-coat methods, in patients undergoing allogeneic hematopoietic stem cell transplantation

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Version 2 2018-10-18, 13:29
Version 1 2018-03-27, 11:14
journal contribution
posted on 2018-10-18, 13:29 authored by Hermógenes Fernández-Muñoz, Eva M. Plaza, José Miguel Rivera-Caravaca, María José Candela, Marta Romera, Felipe De Arriba, María L. Lozano, Vicente Vicente, Inmaculada Heras, Cristina Castilla-Llorente, José Rivera

Objectives: Whole blood-derived platelet concentrates can be obtained by the platelet-rich plasma (PRP-PCs) or the buffy-coat (BC-PCs) method. Few studies have shown that BC-PCs display lower in vitro platelet activation, but scarce information exists regarding transfusion efficacy. We have performed a retrospective study assessing platelet transfusion in patients undergoing allogeneic hematopoietic cell transplantation (AHCT) in our clinic, before and after the implementation of BC-PCs.

Methods: We reviewed clinical records corresponding to 70 PRP-PCs and 86 BC-PCs prophylactic transfusions, which were performed to 55 AHCT patients. Transfusion efficacy was assessed by the 24-h post-transfusion corrected count increment (24-h CCI) and bleeding events. Clinical factors affecting transfusion outcome were also investigated.

Results: Clinical characteristics and the total number of platelet transfusions were similar among groups. Mean donor exposure was 5.8 and 5.0 in each single PRP-PCs and BC-PCs transfusion, respectively (p < 0.01). The 24-h CCI was significantly higher in patients transfused with BC-PCs than in those receiving PRP-PCs (8.3[2.7–13.4] vs. 4.7[1.3–8.1]; p < 0.01). Independent predictors of poor platelet transfusion response included diagnosis other than acute leukemia (HR 8.30; 95% CI 1.96–35.22; p = 0.004), splenomegaly (HR 8.75; 95% CI 2.77–27.60; p < 0.001), graft versus host disease prophylaxis different from cyclosporine A and methotrexate (HR 3.96; 95% CI 1.55–10.14; p = 0.004) and PRP-PCs transfusion (HR 4.54; 95% CI 1.72–12.01; p = 0.002). There were no differences between both groups regarding the bleeding events.

Conclusion: In the AHCT setting, we hypothesize that BC-PCs transfusion, when compared to PRP-PCs, results in higher CCI and reduced donor exposure, but provides no significant benefit regarding bleeding outcome.

Funding

Research by the group of JR is supported by grants from Instituto de Salud Carlos III (PI17/01311, CB15/00055) and Fundación Séneca (19873/GERM/15).

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