Reactions and platelet increments after transfusion of platelet concentrates in plasma or an additive solution: a prospective, randomized study

BACKGROUND: Reactions after platelet transfusions are rather common and frequently are caused by plasma constituents. In recent developments, the preparation and storage of platelet concentrates (PCs) in a platelet additive solution (PAS-2) have been shown to result in acceptable storage conditions. A major drawback of the use of these PCs is the progressive increase of P-selectin-positive platelets during storage. The clinical benefit of transfusions of PCs in PAS-2 was studied. STUDY DESIGN AND METHODS: PCs prepared from buffy coats were suspended in either plasma or PAS-2 and stored for up to 5 days. Clinical responses were evaluated in a prospective study in 21 patients treated with intensive chemotherapy for hematologic malignancies. Eligible patients were randomly assigned to receive prophylactic transfusions of PCs prepared in either plasma or PASP. Reactions and CCls were recorded after each transfusion. RESULTS: The incidence of reactions in 12 patients given PGs in plasma (n = 192) was 12 percent. Transfusions to 9 patients of PCs in PAS-2 (n = 132) showed a reduction in the incidence of reactions to 5.3 percent (p < 0.05). The average 1-hour and 20-hour CCls after transfusion of PCs in plasma were 20.7 +/- 8.5 and 11.5 +/- 8.0, respectively. CCls after transfusion of PGs in PAS-2 were significantly lower: the average 1-hour CCl was 17.1 +/- 6.6 (p < 0.001) and the average 20-hour CCl was 9.5 +/- 7.0 (p < 0.05). Storage conditions of PCs were optimal: in each group, average 1-hour CCls of both fresh and stored PGs were similar. The 20-hour CCls after the transfusion of fresh and stored PCs in PAS-2 also were similar. CONCLUSION: Transfusion of PCs in PAS-2 significantly reduces the incidence of reactions. The 1-hour and 20-hour CCls after transfusion of PCs in PASP were significantly lower than the CCls after transfusion of PCs in plasma. Because storage conditions of both PCs were found to be optimal, the decrease in CCls after transfusion of PGs prepared in PAS-2 may be caused by rapid elimination of a subpopulation of P-selectin-positive platelets from the circulation.