Platelet function testing to assess effectiveness of platelet transfusion therapy

Mohamed Salama, Sundara Raman, Mary Jo Drew, Majdi Abdel-Raheem, Muhammad N. Mahmood

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: Posttransfusion corrected count increments (CCI) following administration of platelets is the standard method for assessing effectiveness of platelet transfusion therapy. However, improvement in platelet count following transfusion may not necessarily indicate improvement in platelet function or restoration of primary hemostatic capacity. To address this possibility, we investigated the effectiveness of platelet transfusion based on results of the Platelet Function Analyzer (PFA-100®) and post-transfusion CCI. Investigation design and methods: Platelet transfusion requests with different indications received at the blood bank were evaluated for inclusion in the investigation. Pre-transfusion, the following laboratory tests were performed: (1) PFA-100 assays (blood collected in 3.2% buffered sodium citrate) performed with CEPI and CADP test cartridges; (2) complete blood count (in EDTA) and platelet count; and (3) routine coagulation profile including PT, PTT, fibrinogen and D-Dimer. Only patients with normal coagulation profiles were included. The same set of tests were performed on a new blood sample collected 10-60 min post-transfusion. Chart review and clinical evaluation for response to platelet therapy were performed on each occasion of transfusion. Results: Thirty-one patients, five of whom were transfused on more than one occasion were evaluated. Thirty-five transfusion incidents were included. Posttransfusion outcomes were divided into two groups - those that resulted in shortening (>40 s) or normalization of the closure time (Group A) and those that had no change or greater prolongation of the closure time (Group B) when compared to the pre-transfusion value. Seventeen and eighteen transfusion episodes were categorized as Groups A and B, respectively. In Group A with improved PFA testing, nine patients had bleeding as indication for transfusion and six of these had concomitant improvement in their clinical picture as confirmed by control of hemorrhage. In contrast in Group B with no improvement in PFA testing, seven patients had bleeding as indication for transfusion and none showed cessation of hemorrhagic symptoms. These findings were statistically significant (p=0.0114). Similar evaluation using the post-transfusion CCI showed no correlation to bleeding symptoms in these patients (p=0.500). Conclusions: In this evaluation, platelet function testing using the PFA-100® provided a better indication of transfusion outcome than did the post-transfusion CCI. Using this approach, PFA-100® may be an effective aid for supporting platelet transfusion decisions and may further aid in improving management of the hospital blood bank platelet inventory.

Original languageEnglish (US)
Pages (from-to)93-100
Number of pages8
JournalTransfusion and Apheresis Science
Volume30
Issue number2
DOIs
StatePublished - Apr 1 2004
Externally publishedYes

Fingerprint

Platelet Transfusion
Blood Platelets
Hemorrhage
Blood Banks
Platelet Count
Therapeutics
Blood Cell Count
Hemostatics
Edetic Acid
Fibrinogen
Equipment and Supplies

Keywords

  • PFA-100
  • Platelet disorders
  • Platelet transfusion

ASJC Scopus subject areas

  • Hematology

Cite this

Platelet function testing to assess effectiveness of platelet transfusion therapy. / Salama, Mohamed; Raman, Sundara; Drew, Mary Jo; Abdel-Raheem, Majdi; Mahmood, Muhammad N.

In: Transfusion and Apheresis Science, Vol. 30, No. 2, 01.04.2004, p. 93-100.

Research output: Contribution to journalArticle

Salama, Mohamed ; Raman, Sundara ; Drew, Mary Jo ; Abdel-Raheem, Majdi ; Mahmood, Muhammad N. / Platelet function testing to assess effectiveness of platelet transfusion therapy. In: Transfusion and Apheresis Science. 2004 ; Vol. 30, No. 2. pp. 93-100.
@article{4304306829494bc6b5df3f5e6354bb76,
title = "Platelet function testing to assess effectiveness of platelet transfusion therapy",
abstract = "Background: Posttransfusion corrected count increments (CCI) following administration of platelets is the standard method for assessing effectiveness of platelet transfusion therapy. However, improvement in platelet count following transfusion may not necessarily indicate improvement in platelet function or restoration of primary hemostatic capacity. To address this possibility, we investigated the effectiveness of platelet transfusion based on results of the Platelet Function Analyzer (PFA-100{\circledR}) and post-transfusion CCI. Investigation design and methods: Platelet transfusion requests with different indications received at the blood bank were evaluated for inclusion in the investigation. Pre-transfusion, the following laboratory tests were performed: (1) PFA-100 assays (blood collected in 3.2{\%} buffered sodium citrate) performed with CEPI and CADP test cartridges; (2) complete blood count (in EDTA) and platelet count; and (3) routine coagulation profile including PT, PTT, fibrinogen and D-Dimer. Only patients with normal coagulation profiles were included. The same set of tests were performed on a new blood sample collected 10-60 min post-transfusion. Chart review and clinical evaluation for response to platelet therapy were performed on each occasion of transfusion. Results: Thirty-one patients, five of whom were transfused on more than one occasion were evaluated. Thirty-five transfusion incidents were included. Posttransfusion outcomes were divided into two groups - those that resulted in shortening (>40 s) or normalization of the closure time (Group A) and those that had no change or greater prolongation of the closure time (Group B) when compared to the pre-transfusion value. Seventeen and eighteen transfusion episodes were categorized as Groups A and B, respectively. In Group A with improved PFA testing, nine patients had bleeding as indication for transfusion and six of these had concomitant improvement in their clinical picture as confirmed by control of hemorrhage. In contrast in Group B with no improvement in PFA testing, seven patients had bleeding as indication for transfusion and none showed cessation of hemorrhagic symptoms. These findings were statistically significant (p=0.0114). Similar evaluation using the post-transfusion CCI showed no correlation to bleeding symptoms in these patients (p=0.500). Conclusions: In this evaluation, platelet function testing using the PFA-100{\circledR} provided a better indication of transfusion outcome than did the post-transfusion CCI. Using this approach, PFA-100{\circledR} may be an effective aid for supporting platelet transfusion decisions and may further aid in improving management of the hospital blood bank platelet inventory.",
keywords = "PFA-100, Platelet disorders, Platelet transfusion",
author = "Mohamed Salama and Sundara Raman and Drew, {Mary Jo} and Majdi Abdel-Raheem and Mahmood, {Muhammad N.}",
year = "2004",
month = "4",
day = "1",
doi = "10.1016/j.transci.2003.10.005",
language = "English (US)",
volume = "30",
pages = "93--100",
journal = "Transfusion and Apheresis Science",
issn = "1473-0502",
publisher = "Elsevier Limited",
number = "2",

}

TY - JOUR

T1 - Platelet function testing to assess effectiveness of platelet transfusion therapy

AU - Salama, Mohamed

AU - Raman, Sundara

AU - Drew, Mary Jo

AU - Abdel-Raheem, Majdi

AU - Mahmood, Muhammad N.

PY - 2004/4/1

Y1 - 2004/4/1

N2 - Background: Posttransfusion corrected count increments (CCI) following administration of platelets is the standard method for assessing effectiveness of platelet transfusion therapy. However, improvement in platelet count following transfusion may not necessarily indicate improvement in platelet function or restoration of primary hemostatic capacity. To address this possibility, we investigated the effectiveness of platelet transfusion based on results of the Platelet Function Analyzer (PFA-100®) and post-transfusion CCI. Investigation design and methods: Platelet transfusion requests with different indications received at the blood bank were evaluated for inclusion in the investigation. Pre-transfusion, the following laboratory tests were performed: (1) PFA-100 assays (blood collected in 3.2% buffered sodium citrate) performed with CEPI and CADP test cartridges; (2) complete blood count (in EDTA) and platelet count; and (3) routine coagulation profile including PT, PTT, fibrinogen and D-Dimer. Only patients with normal coagulation profiles were included. The same set of tests were performed on a new blood sample collected 10-60 min post-transfusion. Chart review and clinical evaluation for response to platelet therapy were performed on each occasion of transfusion. Results: Thirty-one patients, five of whom were transfused on more than one occasion were evaluated. Thirty-five transfusion incidents were included. Posttransfusion outcomes were divided into two groups - those that resulted in shortening (>40 s) or normalization of the closure time (Group A) and those that had no change or greater prolongation of the closure time (Group B) when compared to the pre-transfusion value. Seventeen and eighteen transfusion episodes were categorized as Groups A and B, respectively. In Group A with improved PFA testing, nine patients had bleeding as indication for transfusion and six of these had concomitant improvement in their clinical picture as confirmed by control of hemorrhage. In contrast in Group B with no improvement in PFA testing, seven patients had bleeding as indication for transfusion and none showed cessation of hemorrhagic symptoms. These findings were statistically significant (p=0.0114). Similar evaluation using the post-transfusion CCI showed no correlation to bleeding symptoms in these patients (p=0.500). Conclusions: In this evaluation, platelet function testing using the PFA-100® provided a better indication of transfusion outcome than did the post-transfusion CCI. Using this approach, PFA-100® may be an effective aid for supporting platelet transfusion decisions and may further aid in improving management of the hospital blood bank platelet inventory.

AB - Background: Posttransfusion corrected count increments (CCI) following administration of platelets is the standard method for assessing effectiveness of platelet transfusion therapy. However, improvement in platelet count following transfusion may not necessarily indicate improvement in platelet function or restoration of primary hemostatic capacity. To address this possibility, we investigated the effectiveness of platelet transfusion based on results of the Platelet Function Analyzer (PFA-100®) and post-transfusion CCI. Investigation design and methods: Platelet transfusion requests with different indications received at the blood bank were evaluated for inclusion in the investigation. Pre-transfusion, the following laboratory tests were performed: (1) PFA-100 assays (blood collected in 3.2% buffered sodium citrate) performed with CEPI and CADP test cartridges; (2) complete blood count (in EDTA) and platelet count; and (3) routine coagulation profile including PT, PTT, fibrinogen and D-Dimer. Only patients with normal coagulation profiles were included. The same set of tests were performed on a new blood sample collected 10-60 min post-transfusion. Chart review and clinical evaluation for response to platelet therapy were performed on each occasion of transfusion. Results: Thirty-one patients, five of whom were transfused on more than one occasion were evaluated. Thirty-five transfusion incidents were included. Posttransfusion outcomes were divided into two groups - those that resulted in shortening (>40 s) or normalization of the closure time (Group A) and those that had no change or greater prolongation of the closure time (Group B) when compared to the pre-transfusion value. Seventeen and eighteen transfusion episodes were categorized as Groups A and B, respectively. In Group A with improved PFA testing, nine patients had bleeding as indication for transfusion and six of these had concomitant improvement in their clinical picture as confirmed by control of hemorrhage. In contrast in Group B with no improvement in PFA testing, seven patients had bleeding as indication for transfusion and none showed cessation of hemorrhagic symptoms. These findings were statistically significant (p=0.0114). Similar evaluation using the post-transfusion CCI showed no correlation to bleeding symptoms in these patients (p=0.500). Conclusions: In this evaluation, platelet function testing using the PFA-100® provided a better indication of transfusion outcome than did the post-transfusion CCI. Using this approach, PFA-100® may be an effective aid for supporting platelet transfusion decisions and may further aid in improving management of the hospital blood bank platelet inventory.

KW - PFA-100

KW - Platelet disorders

KW - Platelet transfusion

UR - http://www.scopus.com/inward/record.url?scp=1942518797&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1942518797&partnerID=8YFLogxK

U2 - 10.1016/j.transci.2003.10.005

DO - 10.1016/j.transci.2003.10.005

M3 - Article

C2 - 15062745

AN - SCOPUS:1942518797

VL - 30

SP - 93

EP - 100

JO - Transfusion and Apheresis Science

JF - Transfusion and Apheresis Science

SN - 1473-0502

IS - 2

ER -