[Platelet concentrates from whole-blood donations (buffy-coat) or apheresis: which one to use?]

Platelet concentrates (PCs) prepared either from whole-blood donations by the buffy-coat method (BC), or by plateletpheresis are indicated to prevent or treat acute hemorrhage secondary to thrombocytopenia, and there is an ongoing debate about which platelet product should be used. Usage of each of these two products is highly heterogeneous among countries and individual institutions, ranging from 10 to 90%, with a 50:50 ratio in Europe. In comparison of pooled platelets prepared by the BC method and apheresis PCs, data suggest similar efficacy of the products. Regarding recipients' adverse reactions, there is no advantage for apheresis concentrates. From the donor's point of view, evidence favours using the abundance of platelets available from whole-blood donation. As residual viral transmission risk continues to fall, the advantage of apheresis products related to the decrease to donor exposure lessens. While the cost-effectiveness of apheresis products is comparable to that of other accepted blood safety interventions, in case of emerging pathogens, probably pathogen inactivation of pooled BC PCs would be a more desirable strategy.