Factors influencing moderate to severe reactions to PLT transfusions: experience of the TRAP multicenter clinical trial.
BACKGROUND
During the Trial to Reduce Alloimmunization to Platelets (TRAP Trial), data were prospectively collected for 8769 PLT transfusions regarding the frequency of moderate to severe PLT transfusion reactions.


METHODS
At seven centers, 598 patients were randomly assigned to receive unmodified pooled random-donor PLT concentrates (PCs), UV-B-irradiated PCs, filtered PCs, or filtered random-donor apheresis PLTs.


RESULTS
Moderate to severe transfusion reactions were an increase in temperature of at least 2 degrees C, chills with rigors, extensive urticaria, dyspnea, cyanosis, or bronchospasm. These reactions occurred with 2.2 percent of the transfusions in 22 percent of the patients. Transfusion reactions were associated with WBC counts of more than 5 x 10(6) per transfusion (p = 0.002) and transfusions stored for more than 48 hours (p = 0.02). PLT counts before transfusion were significantly lower for transfusions associated with reactions (p = 0.005). Neither UV-B irradiation nor apheresis PLTs independently influenced reaction rates. The PLT increment at 1 hour after transfusion was lower for transfusions associated with reactions (p = 0.004), and the frequency of reactions was higher in PLT refractory patients (p < 0.001).


CONCLUSIONS
The provision of either fresh and/or WBC-reduced PLTs may decrease the frequency of PLT transfusion reactions and improve PLT transfusion efficacy.
Enright
Helen
H
University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
Davis
Kathryn
K
Gernsheimer
Terry
T
McCullough
Jeffrey J
JJ
Woodson
Robert
R
Slichter
Sherrill J
SJ
D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology*; D001793:Blood Preservation; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects*; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors