What are the recommendations for single donor platelet (SDP) transfusions?

Single Donor Platelet Transfusions

Single-donor apheresis platelets and pooled random-donor platelet concentrates are clinically interchangeable in routine circumstances, with comparable post-transfusion increments, platelet survival, and hemostatic effectiveness. 1

When Single-Donor Platelets Are Required

Single-donor platelets are the only option when histocompatible (HLA-matched) platelets are needed for patients who are refractory to random donor transfusions. 1 This represents the primary absolute indication for single-donor products.

Clinical Equivalence in Routine Use

The evidence consistently demonstrates no clinically meaningful differences between single-donor and pooled products:

• Post-transfusion platelet increments are equivalent between single-donor apheresis platelets and pooled platelet concentrates 1
• Hemostatic benefit is comparable with either product type 1
• Platelet survival is similar regardless of preparation method 1
• Adverse effects occur at similar rates with both products 1

The Alloimmunization Question

A critical randomized trial (TRAP study) definitively addressed whether single-donor platelets reduce alloimmunization:

• Single-donor platelets showed no additional advantage over filtered pooled platelets in reducing alloimmunization or refractoriness 1
• Both leukoreduced single-donor and leukoreduced pooled products reduced lymphocytotoxic antibody formation to 17-21% compared to 45% with unmodified products 1
• The key factor is leukoreduction, not whether platelets come from single or multiple donors 1

Disease Transmission Considerations

The theoretical advantage of reduced donor exposure with single-donor platelets has not translated to measurable clinical benefit:

• No evidence exists that transfusion-transmitted infection rates differ between single-donor and pooled products in oncology patients with contemporary screening and testing 1
• This may be relevant only for patients receiving very few total transfusions 1
• Oncology patients typically require dozens of donor exposures during treatment, negating any theoretical advantage 1

Practical and Economic Factors

Single-donor platelets cost 50-100% more than equivalent doses of pooled concentrates, even accounting for pooling and filtration costs 1

Advantages of single-donor products:

• Most current apheresis procedures produce inherently leukodepleted products (typically <5 × 10⁶ leukocytes) 1
• No pooling required at time of transfusion, reducing staff time 1
• Facilitates HLA matching when needed 1

Advantages of pooled products:

• Lower cost remains significant even after accounting for filtration 1
• Equally effective when leukoreduced 1

Leukoreduction: The Critical Factor

Leukoreduction of both platelet and RBC products should be provided to patients with acute myeloid leukemia from diagnosis to reduce alloimmunization and platelet refractoriness 1, 2

• This recommendation likely extends to other leukemias and cancer patients receiving chemotherapy 1, 2
• Prestorage leukoreduction is now standard in the United States and many countries, making the inherent leukodepletion advantage of apheresis products less relevant 1, 2
• Leukoreduction also reduces febrile reactions and CMV transmission 1, 2

Clinical Decision Algorithm

For routine prophylactic or therapeutic platelet transfusions:

• Use whichever product (single-donor or pooled) is most readily available and cost-effective at your institution 1
• Ensure products are leukoreduced 1, 2

For patients with documented platelet refractoriness due to alloimmunization:

• Use single-donor platelets from HLA-matched or crossmatch-compatible donors 1, 3

For patients with history of severe allergic reactions:

• Consider single-donor platelets to limit donor exposures, though this is not evidence-based 1

Common Pitfalls to Avoid

• Do not assume single-donor platelets prevent alloimmunization better than leukoreduced pooled products—the TRAP trial definitively showed equivalence 1
• Do not use single-donor platelets routinely based solely on theoretical disease transmission benefits—no evidence supports this in patients requiring multiple transfusions 1
• Do not forget that only 10-15% of AML patients actually benefit clinically from alloimmunization prevention strategies, as antibodies often develop late in treatment 1
• Verify your institution's apheresis product specifications—some centers split collections into two products, affecting dosing 1