title: Platelet transfusions in children: results of a randomized, prospective, crossover trial of plasma removal and a prospective audit of WBC reduction.
abstract: BACKGROUND
  Febrile nonhemolytic transfusion reactions (FNHTRs) complicate 2 to 37 percent of platelet transfusions in adults, but the incidence of such reactions in children is not known. The effectiveness of plasma reduction after storage and WBC reduction of platelet concentrates before storage was studied in pediatric recipients of platelet transfusions.
  
  
  METHODS
  In the first study, a prospective randomized crossover design was used in which patients received either unmodified whole-blood-derived or apheresis platelets or platelets from which most of the plasma supernatant had been removed just before transfusion. The second study was a prospective audit of recipients of prestorage WBC-reduced platelets. Children between 3 months and 17 years of age were eligible for both studies. Patients were assessed for signs and symptoms that are characteristic of a reaction during, immediately after, and 2 hours following transfusion.
  
  
  RESULTS
  There were 226 platelet transfusions administered to 66 children. One hundred and sixty transfusions were given to 35 children enrolled in the randomized study, and 66 transfusions were given to 33 children during the audit. In the randomized study, nine of the 75 transfusions of unmodified platelets (12%) and six of 85 transfusions of poststorage plasma-removed platelets (7%) were associated with an FNHTR (p=0.42). In the audit, three of 66 transfusions of prestorage WBC-reduced platelets (5%) were associated with an FNHTR. Allergic reactions occurred with 5 percent (4 of 75), 6 percent (5 of 85), and 6 percent (4 of 66) of platelet transfusions, respectively.
  
  
  CONCLUSIONS
  FNHTRs appear to be less common among pediatric recipients of platelet transfusions than in adults. In our two studies, there was a trend toward a lower frequency of FNHTRs with poststorage plasma removal and prestorage WBC reduction than with standard platelets, but this was not significant.
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. scouban@is.dal.ca
authors.forename: Stephen
authors.initials: S
authors.lastname: Couban
authors.forename: Julie
authors.initials: J
authors.lastname: Carruthers
authors.forename: Pantelis
authors.initials: P
authors.lastname: Andreou
authors.forename: Luba N
authors.initials: LN
authors.lastname: Klama
authors.forename: Ronald
authors.initials: R
authors.lastname: Barr
authors.forename: John G
authors.initials: JG
authors.lastname: Kelton
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Heddle
mesh_terms: D000293:Adolescent; D001793:Blood Preservation; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D016207:Cytokines / Q000009:adverse effects / Q000097:blood; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D006967:Hypersensitivity / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007223:Infant; D007962:Leukocytes; D008297:Male; D008485:Medical Audit; D009369:Neoplasms / Q000150:complications / Q000628:therapy; D009864:Ontario / Q000453:epidemiology; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects / Q000706:statistics & numerical data; D010983:Plateletpheresis; D011446:Prospective Studies
chemical_list: D016207:Cytokines