Department of Haematology, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom.
National Health Service Blood and Transplant, Cambridge, United Kingdom.
Blood. 2017 Jul 13;130(2):214-220. doi: 10.1182/blood-2017-01-759258. Epub 2017 May 9.
The effect of variation in platelet function in platelet donors on patient outcome following platelet transfusion is unknown. This trial assessed the hypothesis that platelets collected from donors with highly responsive platelets to agonists in vitro assessed by flow cytometry (high-responder donors) are cleared more quickly from the circulation than those from low-responder donors, resulting in lower platelet count increments following transfusion. This parallel group, semirandomized double-blinded trial was conducted in a single center in the United Kingdom. Eligible patients were those 16 or older with thrombocytopenia secondary to bone marrow failure, requiring prophylactic platelet transfusion. Patients were randomly assigned to receive a platelet donation from a high- or low-responder donor when both were available, or when only 1 type of platelet was available, patients received that. Participants, investigators, and those assessing outcomes were masked to group assignment. The primary end point was the platelet count increment 10 to 90 minutes following transfusion. Analysis was by intention to treat. Fifty-one patients were assigned to receive platelets from low-responder donors, and 49 from high-responder donors (47 of which were randomized and 53 nonrandomized). There was no significant difference in platelet count increment 10 to 90 minutes following transfusion in patients receiving platelets from high-responder (mean, 21.0 × 10/L; 95% confidence interval [CI], 4.9-37.2) or low-responder (mean, 23.3 × 10/L; 95% CI, 7.8-38.9) donors (mean difference, 2.3; 95% CI, -1.1 to 5.7; = .18). These results support the current policy of not selecting platelet donors on the basis of platelet function for prophylactic platelet transfusion.
血小板供者体外对激动剂的血小板反应性变异对血小板输注后患者结局的影响尚不清楚。本试验评估了如下假说，即通过流式细胞术评估（高反应性供者）的体外对激动剂的血小板反应性高的供者的血小板从循环中清除得更快，与低反应性供者相比，导致输注后血小板计数增加较低。这项平行组、半随机、双盲试验在英国的一个中心进行。符合条件的患者为因骨髓衰竭导致血小板减少症、需要预防性血小板输注的 16 岁及以上患者。当两种供者的血小板都可用时，或当只有一种供者的血小板可用时，患者随机分配接受高或低反应性供者的血小板捐献。参与者、研究者和评估结局的人员对分组情况设盲。主要终点是输注后 10 至 90 分钟的血小板计数增加。分析是基于意向治疗。51 名患者被分配接受低反应性供者的血小板，49 名接受高反应性供者的血小板（其中 47 名随机分组，53 名非随机分组）。输注高反应性供者（平均，21.0×10/L；95%置信区间[CI]，4.9-37.2）或低反应性供者（平均，23.3×10/L；95%CI，7.8-38.9）的血小板后 10 至 90 分钟的血小板计数增加无显著差异（平均差值，2.3；95%CI，-1.1 至 5.7；P=.18）。这些结果支持目前对预防性血小板输注不根据血小板功能选择血小板供者的政策。
