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2386 Part XIII: Transfusion Medicine Chapter 139: Preservation and Clinical Use of Platelets 2387

1.0
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Probability of remaining event free 0.7 Probability of remaining event free 0.7
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0.0 0.0 0 5 10 15 20 25 30 35
0 5 10 15 20 25 30 35 B Time since first platelet transfusion (days)
A Time since first platelet transfusion (days) No. Patients at Risk
No. Patients at risk ABO Identical 467 215 78 31 10 3 1
Apheresis 552 338 168 68 32 16 4 Minor Mismatch 75 30 8 2 1 1
WBP 220 119 56 30 15 5 Major Mismatch 198 72 27 5
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C Time since first platelet transfusion (days)
No. Patients at risk
0-2 Days 48 13 5
3 Days 158 47 16 1
4 Days 223 69 13 1
5 Days 221 71 23 4 1 1
Figure 139–4. Kaplan-Meier plots of time from platelet transfusion to first Grade 2 or higher bleeding for each platelet characteristic. A. Time
from first platelet transfusion to first Grade 2 or higher bleeding by source of platelets. Time to bleeding was censored at the first date that any of
the following occurred: transfusion of a platelet unit with a different source from the patient’s initial platelet transfusion; missing data on whether
Grade 2 or higher bleeding occurred; or end of study. Platelet source was not a significant predictor of time to Grade 2 or higher bleeding (p = 0.44).
Apheresis platelets ( ) and random-donor whole-blood platelets (rdWBPs) ( ). B. Time from first platelet transfusion to first Grade 2 or higher bleeding
by ABO matching status from the patient’s initial platelet transfusion or missing data on ABO matching status; missing data on whether Grade 2 or
higher bleeding occurred; or end of study. Divergence of the curves after 15 days is probably the result of the small number of patients still at risk
by that time. ABO matching status was not a significant predictor of time to Grade 2 or higher bleeding (p = 0.33). ABO identical platelets ( ), ABO
minor mismatched platelets ( ), and major ABO mismatched platelets ( ). C. Time from first platelet transfusion to first Grade 2 or higher bleeding,
by platelet storage duration, among patients whose first platelet transfusion was stored for 0 to 5 days. Time to bleeding was censored at the first
date that any of the following occurred: transfusion of a platelet unit with a different storage duration from the patient’s initial platelet transfusion;
transfusion of a platelet unit with missing data on storage duration; transfusion of pooled rdWBPs of different storage durations; missing data on
whether Grade 2 or higher bleeding occurred; or end of study. Divergence of the curves after 10 days is probably the result of the small number of
patients still at risk by that time. Duration of platelet storage was not a significant predictor of time to Grade 2 or higher bleeding (p = 0.87). Platelet
storage times: 0 to 2 days ( ), 3 days ( ), 4 days ( ), and 5 days ( ). (Reproduced with permission from Triulzi DJ, Assmann SF, Strauss RG, et al: The impact of
platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypo-proliferative thrombocytopenia. Blood
7;119(23):5553–5562, 2012.)
multiinstitutional PLADO trial provides new information on the PLATELET INCREMENTS, CORRECTED COUNT
relative merits of the two products. The PLADO trial involved 1272
6
platelet-transfused patients who received 8994 platelet transfusions of INCREMENTS, AND TRANSFUSION INTERVAL
which 6031 were given prophylactically. The patients were observed In the PLADO trial, the absolute increments for rdWBPs at 4
for 24,309 days. Subsets of this database were used to analyze bleeding hours posttransfusion were on average 3.5 × 10 /L lower than APs
9
outcomes, posttransfusion increments, and CCI within 4 and 24 hours (p = 0.002), and CCIs were 1400 less (p = 0.01), with no differences
posttransfusion, and transfusion intervals based on blood product for these parameters at 24 hours. Major ABO-incompatible (donor
65
transfused, ABO matching between donor and recipient, and duration red cell A or B antigens incompatible with recipient’s anti-A or anti-B
of platelet storage. 65 antibodies), but not ABO-minor (donor’s anti-A or anti-B antibodies
incompatible with recipient’s red cell A or B antigens), transfusions were
Time to Bleeding associated with lower increments of 2.2 × 10 /L (p = 0.0001) and lower
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Importantly, in the PLADO trial neither differences in platelet prod- CCIs of 1.4 × 10 /L (p <0.0001) at 4 hours posttransfusion, respectively,
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uct, ABO matching, nor in storage duration affected time to bleeding compared to ABO-identical transfusions. Similarly, at 24 hours post-
(Fig. 139–4). 65 transfusion, major ABO-mismatched transfusions had lower platelet

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