Effect of platelet storage duration on platelet increment and clinical outcomes in critically ill patients – A randomised controlled trial - 23/11/24

Doi : 10.1016/j.tracli.2024.11.001

Vivek Muraleedharan ^a, Paramjit Kaur ^a,^⁎ , Kshitija Mittal ^a, Sanjeev Palta ^b, Ravneet Kaur ^a, Gagandeep Kaur ^a
^a Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India
^b Department of Anaesthesia, Government Medical College and Hospital, Chandigarh, India

^⁎Corresponding author at: Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh, India.Department of Transfusion MedicineGovernment Medical College and HospitalChandigarhIndia

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 23 November 2024

Highlights

•	The median Corrected Count Increment (CCI) and Percentage Platelet Recovery (PPR) were significantly higher in the fresher platelet group at 24 h.
•	There was no significant difference between the fresher and older platelet groups in terms of bleeding, infection rates, ICU stay, or mortality.
•	Patients with higher APACHE-III scores and co-morbidities had increased mortality, irrespective of platelet storage duration.

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Abstract

Background and objectives

Platelet storage duration may influence transfusion effectiveness and patient outcomes.The present study aimed to evaluate the effect of platelet storage duration on platelet increment and clinical outcomes in patients admitted to the intensive care unit (ICU).

Material and methods

This prospective, open-label, randomized controlled trial, conducted at a single centre, enrolled ICU patients requiring platelet transfusion. Patients were randomly assigned to receive platelet concentrates aged ≤ 3 days (Group 1) or 4–5 days (Group 2). Platelet increments were assessed by Absolute Platelet Count Increment (ACI), Corrected Count Increment (CCI), and Percentage Platelet Recovery (PPR). Clinical outcomes including bleeding, infection rates, ICU stay, red cell transfusion requirements, and mortality were also monitored.

Results

Patients transfused fresher platelets (Group 1) had higher median ACI, CCI and PPR at 1 h compared to those transfused older platelets (Group 2) though the difference was not statistically significant. At 24 h, Group 1 patients had a median ACI of 28,000/µl compared to 14,000/µl in Group 2(p = 0.001). The median CCI was 16,800 in Group 1 versus 8,200 in Group 2(p = 0.001). Group 1 also had a higher median PPR of 45.7% compared to 23.6% in Group 2(p = 0.011).There was no significant difference in clinical outcomes such as bleeding, infection rates, ICU stay, or mortality between the groups. Multivariate analysis indicated that co-morbidities and higher APACHE-III score were associated with increased mortality.