Platelet function testing to assess effectiveness of platelet transfusion therapy.
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.
Salama
Mohamed E
ME
Department of Pathology-K6, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202, USA.
Raman
Sundara
S
Drew
Mary Jo
MJ
Abdel-Raheem
Majdi
M
Mahmood
Muhammad N
MN
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001771:Blood Banks; D001772:Blood Cell Count; D001792:Blood Platelets / Q000502:physiology; D001803:Blood Transfusion; D004492:Edetic Acid / Q000494:pharmacology; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000096:biosynthesis; D005340:Fibrinogen / Q000096:biosynthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D010979:Platelet Function Tests / Q000379:methods*; D017713:Platelet Transfusion / Q000379:methods*; D013048:Specimen Handling; D013997:Time Factors; D016896:Treatment Outcome
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen; D004492:Edetic Acid