Safety and Efficacy of Amotosalen-UVA Pathogen Reduced Platelets Transfused to Neonates

Introduction: To compare the efficacy and safety of Amotosalen/ultraviolet A (UVA) pathogen reduced platelets (PRPC) with conventional platelets for transfusion of term and pre-term neonates who are vulnerable to transfusion-transmitted infections (TTI) and transfusion associated graft versus host disease (TA-GVHD). Safety and efficacy of concomitant use of PRPC and phototherapy treatment with a specific focus on a large cohort of premature neonates has not been investigated before. Methods: In this retrospective cohort study, medical records were audited for gestational age, birth weight, number of transfusions, platelet count and transfusion increments, maximum bilirubin, phototherapy, and transfusion related adverse events. Term and pre-term neonates were transfused with conventional PC (CPC) during a period of 72 months (2005-2010) before PRPC and during 57 months after PRPC implementation (2011-2015). Use of fresh frozen plasma (FFP) and Red Blood Cells (RBC) were surrogate hemostasis indicators. Results: In the first cohort, 92 neonates received 180 CPC and in the second cohort 99 neonates received 225 PRPC. Similar proportions of patients in each cohort had bleeding (central nervous system 18% vs 19%, pulmonary 3.0% vs 3.3%). The gestational ages and birth weights were similar (33.1 vs 33.0 weeks and 1.8Kg for both). The proportion of multiple births (twins, triplets) was significantly higher in the PRPC cohort (27 vs 6). Neonates treated with PRPC received more concomitant phototherapy treatments (3.8 vs 2.4). There were no differences in PC, FFP or RBC units transfused. Mean platelet count increments were not different (PRPC: 82.9±45.1 vs CPC: 95.9±53.0). No patients had transfusion-related phototoxicity. Conclusion: The study demonstrated PRPC efficacy and safety for term and pre-term neonates with or without concurrent phototherapy.