Ning Shuoyan, Gabarin Nadia, Li Na, Liu Yang, Lucier Kayla, Barty Rebecca, Acker Jason, Webert Kathryn E, Warkentin Theodore E, Arnold Donald M, Heddle Nancy M
Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada.
Transfusion. 2023 Mar;63(3):480-493. doi: 10.1111/trf.17272. Epub 2023 Feb 6.
In August 2017, Canadian Blood Services extended the shelf-life of platelet concentrates from 5 to 7 days. The clinical impacts of this policy change remain unclear.
We used a before-after retrospective design of platelet-transfused adult inpatients in Hamilton, ON, Canada. Data were captured for 18 months before (Period 1: February 2016-July 2017) and 18 months after (Period 2: September 2017-February 2019) 7-day platelet implementation. Primary outcome was absolute platelet count increment (ACI) in univariate and multivariate analyses adjusted for confounders. Data were obtained from our institution's transfusion database, Ontario's Transfusion Transmitted Injuries Surveillance System, and the blood supplier.
Overall, 1360 patients with single dose platelet transfusions were included in Period 1 and 1211 patients in Period 2. Median age at admission was 66 years, and approximately 40% of patients underwent cardiac surgery. Using a non-inferiority margin of -10 × 10 /L, platelets transfused during the 7-day storage period were non-inferior to those transfused in the 5-day storage period [mean count difference - 4.63 × 10 /L (95% CI -7.40 to -1.87, p = 0.0001)]. However, platelet ACIs following transfusion consistently trended lower in the 7-day group for all patients and subgroups. No differences in secondary clinical outcomes were observed. Platelet expiry reduced from 8.1 to 6.3% (p < 0.0001).
Platelet transfusions following 7-day storage policy were non-inferior to transfusions in the 5-day policy period, although reduced ACIs were observed. There were no increases in adverse clinical outcomes.
2017年8月，加拿大血液服务中心将血小板浓缩液的保质期从5天延长至7天。这一政策变化的临床影响尚不清楚。
我们采用前后回顾性设计，研究对象为加拿大安大略省汉密尔顿市接受血小板输注的成年住院患者。收集了7天血小板实施前18个月（第1阶段：2016年2月至2017年7月）和实施后18个月（第2阶段：2017年9月至2019年2月）的数据。主要结局是在对混杂因素进行调整的单变量和多变量分析中的绝对血小板计数增加值（ACI）。数据来自我们机构的输血数据库、安大略省的输血传播损伤监测系统以及血液供应商。
总体而言，第1阶段纳入了1360名单剂量血小板输注患者，第2阶段纳入了1211名患者。入院时的中位年龄为66岁，约40%的患者接受了心脏手术。使用-10×10⁹/L的非劣效性界值，在7天储存期内输注的血小板不劣于在5天储存期内输注的血小板[平均计数差异为-4.63×10⁹/L（95%CI -7.40至-1.87，p = 0.0001）]。然而，在7天组中，所有患者和亚组输血后的血小板ACI持续呈下降趋势。未观察到次要临床结局的差异。血小板过期率从8.1%降至6.3%（p < 0.0001）。
尽管观察到ACI降低，但7天储存政策下的血小板输注不劣于5天政策期内的输注。不良临床结局没有增加。
