Patient and product factors affecting platelet transfusion results

BACKGROUND: Providing patients with platelet (PLT) transfusions requires important logistic resources and represents a considerable cost factor. Optimizing PLT transfusions is in the interest of not only patient safety but also economic importance. Only few studies have evaluated factors associated with transfusion results. STUDY DESIGN AND METHODS: In a prospective single-center study, 9923 mainly prophylactic PLT transfusions given to 672 patients treated for hematologic malignancies between 1997 and 2004 were investigated. Patient and product factors were analyzed. Transfusion efficacy was measured by the corrected count increment (CCI), and side effects were recorded. RESULTS: The mean CCI of all transfusions was 14.05 (standard deviation, 9.5). The CCI correlates with the transfusion interval. PLT transfusions that resulted in a transfusion interval of 1 day or less had significantly lower CCI of 11.3 than transfusions that resulted in a transfusion interval of 2 days or more (15.57). Allogeneic stem cell transplant recipients had a significantly lower transfusion efficacy (CCI mean, 13.3) whereas patients treated with antithymocyte globulin (ATG) had better CCIs (17.2) compared to patients who were treated with chemotherapy only. Longer PLT storage time and ABO mismatch had a negative impact on transfusion efficacy. PLTs stored in PLT additive storage solution were less effective than PLTs stored in their own autologous plasma. CONCLUSION: Manipulation of PLT products may result in lower transfusion efficacy as illustrated by the introduction of PLT additive storage solution in this report. The higher number of products used per patient may negatively impact on advantages gained by the transfusion of "safer" PLT products.