Rai Herleen, Forsythe Kyle, Smith Nyle, Smetana Heather, Neally Melissa A, Marshall Christi, Francischetti Ivo M B, Ness Paul M, Bloch Evan M, Tobian Aaron A R, Crowe Elizabeth P
Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Greater Baltimore Medical Center, Baltimore, Maryland, USA.
Transfusion. 2024 Dec;64(12):2222-2227. doi: 10.1111/trf.18055. Epub 2024 Nov 6.
Splitting apheresis platelet (PLT) units increase available inventory during shortages. The impact of prolonged storage in gas-impermeable aliquot bags on PLT quality in vitro and transfusion outcomes in patients remains uncertain.
We assessed in vitro PLT quality and thromboelastography (TEG) in PLTs stored for 8 or 24 h in aliquot bags compared with baseline (T0). Retrospective assessment of response (PLT increment and corrected count increment (CCI)) was conducted among adults (≥18 years) transfused with split platelet units from January 2021 to June 2022.
No differences were observed in PLT and white blood cell (WBC) counts, mean platelet volume, or TEG parameters during storage, except for an increase in TEG R time (mean ± SD) at 24 h (6.1 ± 0.5 min) compared to T0 (4.4 ± 0.8 min), p = 0.0031 one-way ANOVA. Eighty-one patients were transfused 119 split units with a median [IQR] PLT yield of 2.1 × 10[1.9 × 10 to 2.3 × 10] and storage duration of 1.6[0.7-9.1] h. The overall median PLT count increment was 6.0 × 10/uL and CCI was 5.0 × 10, correlating negatively with split unit storage duration (Spearman rho = -0.218, p = 0.017). Compared with split transfusions of pathogen-reduced (PR) PLTs, non-PR splits were associated with higher median platelet count increments (7.0 × 10/μL vs. 4.0 × 10/μL, p = 0.0263 Mann-Whitney U) and higher CCIs (6.5 × 10 vs. 3.9 × 10, p = 0.0116 Mann-Whitney U) despite no differences in PLT yields (2.1 × 10/μL vs. 2.1 × 10/μL).
Storing PLTs in aliquot bags for 8 or 24 h does not adversely affect their quality in vitro. Splitting apheresis PLTs are feasible for adult transfusions during shortages. It may be advisable to prioritize non-PR PLTs for splitting given improved patient responses.
在血小板短缺期间，分割单采血小板（PLT）单位可增加可用库存。在不透气的分装袋中长时间储存对PLT体外质量和患者输血结果的影响仍不确定。
我们评估了与基线（T0）相比，在分装袋中储存8小时或24小时的PLT的体外PLT质量和血栓弹力图（TEG）。对2021年1月至2022年6月接受分割血小板单位输血的成年人（≥18岁）进行了反应（PLT增量和校正计数增量（CCI））的回顾性评估。
在储存期间，PLT和白细胞（WBC）计数、平均血小板体积或TEG参数均未观察到差异，除了24小时时TEG R时间（平均值±标准差）增加（6.1±0.5分钟），与T0（4.4±0.8分钟）相比，p = 0.0031（单因素方差分析）。81名患者输注了119个分割单位，PLT中位数[四分位间距]产量为2.1×10[1.9×10至2.3×10]，储存时间为1.6[0.7 - 9.1]小时。总体PLT计数中位数增量为6.0×10/uL，CCI为5.0×10，与分割单位储存时间呈负相关（Spearman相关系数rho = -0.218，p = 0.017）。与病原体灭活（PR）PLT的分割输血相比，非PR分割与更高的PLT计数中位数增量（7.0×10/μL对4.0×10/μL，p = 0.0263，Mann-Whitney U检验）和更高的CCI（6.5×10对3.9×10，p = 0.0116，Mann-Whitney U检验）相关，尽管PLT产量无差异（2.1×10/μL对2.1×10/μL）。
在分装袋中储存PLT 8小时或24小时不会对其体外质量产生不利影响。在短缺期间，分割单采PLT用于成人输血是可行的。鉴于患者反应改善，优先分割非PR PLT可能更为可取。
