The utility of <= 3-day-old whole-blood platelets in reducing the incidence of febrile nonhemolytic transfusion reactions

BACKGROUND: Febrile nonhemolytic transfusion reactions (FNHTRs) to platelet transfusions have been linked to the presence of cytokines in supernatant plasma. Cytokine concentration is directly related to WBC content and stora ge time. This study evaluated the effect of limiting the storage time of ra ndom-donor platelet concentrates on the FNHTR rate. STUDY DESIGN AND METHODS: FNHTR rates were calculated retrospectively for s ingle-donor apheresis platelet (SDP) and pooled random-donor platelet (PP) transfusions given during three consecutive 5-month study periods (November 1995 to February 1997) to patients on a single hematology/oncology/bone ma rrow transplant unit. Transfusion practice policies were: Baseline Period, SDPs preferred; Study Period A, PPs preferred; and Study Period B, less tha n or equal to 3-day-old PPs preferred. FNHTR rates were calculated from phy sicians' interpretations of reported reactions and the total number of SDP and PP transfusions in each period. SDPs were collected on two cell separat ors. All platelet components were filtered at issue in the laboratory by WB C-reduction filters. RESULTS: FNHTR rates for PP transfusions were: baseline, 11.1 percent(3/27) ; Study Period A, 4.6 percent (22/481); and Study Period B, 1.1 percent(3/2 82). The rates for SDP transfusions were 0.15 percent (1/650), 0.75 percent (2/267), and 0.36 percent (1/273), respectively. The FNHTR rate for 13-day -old PPs was significantly less than the rate for older PPs (p = 0.0086 for Study Period A vs. Study Period B), and was not significantly different th an that for SDPs (p = 0.33 for PPs vs. SDPs in Study Period B). CONCLUSION: Limiting transfusion of PPs to those stored less than or equal to 3 days is an effective strategy in reducing the rate of FNHTR and result s in an FNHTR rate comparable to that seen with SDPs.