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Platelet storage duration and its clinical and transfusion outcomes: a systematic review
Cécile Aubron1,2, Andrew W J Flint3,4, Yves Ozier5
1The Medical Intensive Care Unit, Centre Hospitalier et Universitaire de Brest - Université de Bretagne Occidentale, Bvd Tanguy Prigent, 29609, Brest Cedex, France. Cecile.aubron@chu-brest.fr.
Insights
Platelet storage time up to 7 days did not affect mortality or sepsis in critically ill or hematology patients. Fresher platelets showed better corrected count increment, but this did not impact bleeding events.
Area of Science:
- Transfusion Medicine
- Hematology
- Critical Care Medicine
Background:
- Platelets (PLTs) are typically stored for up to 5 days, with some services extending this to 7 days.
- Storage can induce PLT activation and dysfunction, but the clinical impact is unclear.
Purpose of the Study:
- To systematically review the association between platelet storage duration and clinical or transfusion outcomes.
- To evaluate the impact of platelet age on patient health and transfusion effectiveness.
Main Methods:
- Systematic review of studies published between January 2000 and July 2017.
- Searched MEDLINE, Embase, PubMed, and Cochrane Libraries for relevant English-language studies.
- Included studies involving critically ill and hematology patients receiving allogeneic platelet transfusions.
Main Results:
- In critically ill patients (n=4719), no association was found between storage time (up to 5 days) and mortality or sepsis.
- In hematology patients (n=8569), fresher platelets (<3 days) showed improved corrected count increment (CCI) in most studies.
- One study indicated increased bleeding events with older platelets, but overall clinical outcomes were not significantly affected by storage duration.
Conclusions:
- Platelet storage time does not appear to significantly impact clinical outcomes like bleeding, sepsis, or mortality in critically ill or hematology patients.
- While fresher platelets may improve CCI, their clinical significance regarding bleeding events is questionable.
- More evidence is needed for definitive conclusions, particularly in critically ill populations.
Background:
Platelets (PLTs) are usually stored for up to 5 days prior to transfusion, although in some blood services the storage period is extended to 7 days. During storage, changes occur in both PLT and storage medium, which may lead to PLT activation and dysfunction. The clinical significance of these changes remains uncertain.
Methods:
We performed a systematic review to assess the association between PLT storage time and clinical or transfusion outcomes in patients receiving allogeneic PLT transfusion. We searched studies published in English between January 2000 and July 2017 identified from MEDLINE, Embase, PubMed and the Cochrane Libraries.
Results:
Of the 18 studies identified, five included 4719 critically ill patients (trauma, post-cardiac surgery and a heterogeneous population of critically ill patients) and 13 included 8569 haematology patients. The five studies in critically ill patients were retrospective and did not find any association between PLT storage time when PLTs were stored for up to 5 days and mortality. There was also no association between older PLTs and sepsis in the two largest studies (n = 4008 patients). Of the 13 studies in haematology patients, seven analysed prolonged storage time up to 6.5 or 7 days. Administration of fresh PLTs (less than 2 or 3 days) was associated with a significant increase in corrected count increment (CCI) compared to older PLTs in seven of the eight studies analysing this outcome. One single centre retrospective study found an increase in bleeding events in patients receiving older PLTs.
Conclusions:
PLT storage time does not appear to be associated with clinical outcomes, including bleeding, sepsis or mortality, in critically ill patients or haematology patients. The freshest PLTs (less than 3 days) were associated with a better CCI, although there was no impact on bleeding events, questioning the clinical significance of this association. However, there is an absence of evidence to draw definitive conclusions, especially in critically ill patients.
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