Can platelet concentrate cause a transfusion reaction?

Can Platelet Concentrate Cause Transfusion Reactions?

Yes, platelet concentrates can cause transfusion reactions and are, in fact, associated with a high frequency of adverse reactions compared to other blood components.

Types of Transfusion Reactions Associated with Platelet Concentrates

Febrile and Allergic Reactions (Most Common)

• Febrile, nonhemolytic transfusion reactions are the most frequent adverse reactions to platelet transfusions 1, 2, 3.

• The overall estimated incidence of hypersensitivity transfusion reactions (HTRs) following platelet concentrate administration is approximately 232 per 100,000 transfusions 4.

• These reactions commonly present with fever, chills, or urticaria in awake patients 1.

• Most febrile reactions are caused by bioreactive substances (cytokines such as interleukin-1 beta and interleukin-6) that accumulate in the plasma supernatant during storage, not by leukocyte-antibody interactions as traditionally believed 5.

• Reaction rates increase significantly with storage time: 8.7% for platelets stored less than 3 days versus 17.6% for platelets stored 3 days or more 6.

Severe Life-Threatening Reactions (Rare but Critical)

Bacterial Contamination and Sepsis:

• Bacterial contamination of platelet concentrates is the leading cause of death from blood transfusions 1.
• The increased risk relates to storage temperature of 20-24°C, which promotes bacterial overgrowth 1.
• If a patient develops fever within 6 hours after receiving platelets, sepsis from contaminated platelets should be suspected 1.

Transfusion-Related Acute Lung Injury (TRALI):

• TRALI is one of the top three most common causes of transfusion-related deaths 1.
• Symptoms appear 1-2 hours after transfusion and reach maximum intensity within 6 hours 1.
• Clinical presentation includes hypoxia, fever, dyspnea, and potentially fluid in the endotracheal tube 1.
• No specific therapy exists beyond stopping transfusion and instituting critical care supportive measures; most patients recover within 96 hours 1.

Anaphylactic Reactions:

• Severe anaphylactic episodes can occur, though they are rare 2.

Hemolytic Reactions

• Both hemolytic and nonhemolytic transfusion reactions can occur 1.
• Signs of hemolytic reactions include hypotension, tachycardia, hemoglobinuria, and microvascular bleeding 1.

Risk Factors and Product-Specific Considerations

Type of Platelet Product:

• Apheresis platelet concentrates have a significantly higher rate of HTRs (337 per 100,000) compared to buffy-coat platelets (94 per 100,000) 4.
• Platelets in additive solutions (PAS) are associated with significantly lower frequency of HTRs compared to platelets in native plasma 4.

Storage Duration:

• Longer storage time correlates with higher reaction rates due to accumulation of pyrogenic and vasoactive substances in the plasma 6.

Critical Pitfalls in Anesthetized Patients

General anesthesia may mask the symptoms of both hemolytic and nonhemolytic transfusion reactions 1. Therefore:

• Periodically check for signs and symptoms of transfusion reactions in anesthetized patients 1.
• Assess urine output and color 1.
• Monitor peak airway pressure 1.
• Signs that may be erroneously attributed to other causes include hypotension, tachycardia, hemoglobinuria, and microvascular bleeding 1.

Clinical Management Approach

When Transfusion Reaction is Suspected:

• Stop the transfusion immediately 1.
• Institute critical care supportive measures as needed 1.
• If fever develops within 6 hours of platelet transfusion, consider bacterial contamination and initiate sepsis workup 1.
• For TRALI, provide respiratory support; most patients recover within 96 hours 1.

Prevention Strategies:

• Use leukoreduced platelet products when available 1.
• Consider removing plasma supernatant before transfusion to minimize febrile reactions 5.
• Use platelets in additive solutions rather than native plasma when possible 4.
• Minimize storage time when feasible 6.