A retrospective evaluation of responsiveness to platelets in plasma and pathogen‐reduced platelets in platelet additive solution at a single institution

BACKGROUND: Studies suggest that recipients of pathogen reduced (PR) platelets in platelet additive solution (PAS) experience inferior increments when compared to platelets in plasma (PS); however, few real-world studies have confirmed these observations. In this single-center study, we evaluated responses to PS and PAS/PR platelets in platelet-refractory, predominantly hematology/oncology patients. STUDY DESIGN/METHODS: Two analyses were performed. First, 1-h CCIs from recipients of all available PS and PAS/PR units within the same hospitalization were compared using mixed effects modeling. Clinical factors potentially contributing to refractoriness were also recorded. Second, total platelet utilization per allogeneic hematopoietic stem cell transplant (HSCT) encounter prior to and following platelet inventory transition to exclusively PAS/PR platelets were compared using negative binomial regression. RESULTS: Forty-one subjects met inclusion criteria. Most subjects (95%) were diagnosed with platelet refractoriness, and 44% had detectable HLA allosensitization. Post-transfusion CCIs with single-donor PS platelets were significantly greater than that with single-donor or HLA-selected/crossmatched PAS/PR platelets (6598 vs. 2177 and 3091, p < .001). No transfusion reactions with PS platelets were reported. The median total platelet transfusions per HSCT encounter increased over two-fold following transition to PAS/PR platelet inventory (IRR 2.29, 95% CI 1.75-2.99). No differences in mean platelet engraftment times were noted over this period. DISCUSSION: Our findings suggest that the transition to predominantly PAS/PR platelet units may have contributed to clinical platelet refractoriness and increased platelet utilization in a selected cohort of hematology/oncology patients. These findings may have wider implications for platelet inventory management in tertiary healthcare systems.