A randomized noninferiority crossover trial of corrected count increments and bleeding in thrombocytopenic hematology patients receiving 2- to 5- versus 6- or 7-day-stored platelets.
BACKGROUND
Bacterial screening offers the possibility of extending platelet (PLT) storage to Day 7. We conducted a noninferiority, crossover trial comparing PLTs stored for 6 or 7 days versus 2 to 5 days.


METHODS
Stable hematology patients were allocated to receive blocks of 2- to 5- and 6- or 7-day PLTs in random order. The primary outcome was the proportion of successful transfusions during the first block, defined as a corrected count increment (CCI) of more than 4.5 at 8 to 24 hours posttransfusion.


RESULTS
Of 122 patients with an evaluable first block, 87 (71%) and 84 (69%) had successful transfusions after 2- to 5- and 6- or 7-day PLTs of mean (SD) ages of 3.8 (1.0) and 6.4 (0.5) days, respectively. Six- or 7-day PLTs were declared noninferior to 2- to 5-day PLTs since the upper confidence interval (CI) limit was less than the predefined noninferiority margin of 10% (95% CI, -14.0% to 9.1%; p = 0.766). Logistic regression analysis gave an adjusted odds ratio of 0.86 (95% CI, 0.47-1.58; p = 0.625). Mean (SD) 8- to 24-hour CCIs were 9.4 (7.9) and 7.7 (7.1) after transfusion with 2- to 5- or 6- or 7-day PLTs (95% CI, -3.31 to 0.03; p = 0.054). The proportions of days with bleeding scores of WHO Grade 2 or higher were 13% (38/297 days) and 11% (32/296 days; 95% CI, -3.2 to 7.2; p = 0.454). Median interval to next PLT transfusion (2 days) was unaffected (95% CI, -10.5 to 5.4; p = 0.531).


CONCLUSIONS
In hematology patients, there was no evidence that 6- or 7-day PLTs were inferior to 2- to 5-day PLTs, as measured by proportion of patients with successful transfusions, bleeding events, or interval to next transfusion.
NHSBT Leeds Centre, Leeds, UK.
Sheila
S
MacLennan
NHSBT Filton Centre, Bristol, UK.
Kay
K
Harding
NHSBT Cambridge Centre, Cambridge, UK.
Charlotte
C
Llewelyn
MRC Clinical Trials Unit, London, UK.
Louise
L
Choo
NHSBT Cambridge Centre, Cambridge, UK.
Lekha
L
Bakrania
NHSBT Filton Centre, Bristol, UK.|Bristol Royal Infirmary, Bristol, UK.
Edwin
E
Massey
NHSBT Oxford Centre, John Radcliffe Hospital, Oxford, UK.
Simon
S
Stanworth
NHSBT Manchester Centre.|Manchester Royal Infirmary, Manchester, UK.
Kate
K
Pendry
NHSBT, Herts, UK.
Lorna M
LM
Williamson
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology; D001769:Blood / Q000382:microbiology; D001793:Blood Preservation; D016026:Bone Marrow Transplantation; D018592:Cross-Over Studies; D004866:Equipment Contamination; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome