From the Guidelines
Most infusion reactions occur with platelets primarily due to their high plasma content and the presence of various bioactive substances. Platelets contain significantly more plasma than other blood components, which increases the likelihood of reactions to plasma proteins. These reactions typically manifest as allergic or febrile non-hemolytic transfusion reactions. The bioactive substances in platelets include cytokines, chemokines, and other inflammatory mediators that accumulate during platelet storage, particularly interleukin-1, interleukin-6, and tumor necrosis factor-alpha, as noted in studies such as 1.
Some key points to consider include:
- Platelets must be stored at room temperature, limiting their shelf life to only 5 days due to the risk for bacterial growth during storage, as mentioned in 2.
- Platelet transfusion is associated with several risks to the recipient, including allergic reactions and febrile nonhemolytic reactions, with sepsis from a bacterially contaminated platelet unit representing the most frequent infectious complication from any blood product today, as highlighted in 3.
- The AABB provides guidelines for platelet transfusion, including recommendations for prophylactic platelet transfusion in certain clinical situations, such as elective diagnostic lumbar puncture or major elective nonneuraxial surgery, as outlined in 4.
To manage these reactions, premedication with antihistamines like diphenhydramine (25-50mg) and/or acetaminophen (650mg) 30 minutes before transfusion is often recommended for patients with previous reactions, as suggested by various studies including 1. For severe or recurrent reactions, washed platelets or platelets from HLA-matched donors may be necessary. Slowing the infusion rate and careful monitoring during the first 15 minutes of transfusion when most reactions occur can also help minimize adverse effects.
From the Research
Infusion Reactions with Platelets
- Infusion reactions are a significant concern in transfusion medicine, and platelets are one of the most common blood components associated with these reactions 5, 6.
- The high incidence of infusion reactions with platelets can be attributed to the complex series of changes that occur during storage, including partial activation, up-regulation of inflammatory mediators, and cellular morphology changes 5.
- Platelets are active metabolizing cells that can release a variety of cytokines, chemokines, and biological response modifiers, which can contribute to the development of infusion reactions 6.
- The process of platelet preparation and preservation, as well as incompatibilities between blood donors and recipients, can also play a role in the activation of platelets and the release of these molecules 6.
Comparison with Other Blood Components
- While infusion reactions can occur with other blood components, platelets are particularly prone to causing these reactions due to their labile nature and the potential for activation during storage 5, 6.
- Other blood components, such as red blood cells and plasma, are less likely to cause infusion reactions, although they can still occur 7.
- The unique characteristics of platelets, including their ability to release cytokines and other biological response modifiers, make them more likely to cause infusion reactions compared to other blood components 6.
Management and Prevention
- Understanding the pathophysiology of infusion reactions with platelets is crucial for developing effective management and prevention strategies 5, 6.
- Measures such as improving the quality of blood transfusion products, enhancing hemovigilance, and implementing evidence-based algorithms for transfusion can help reduce the incidence of infusion reactions 7.
- Additionally, careful patient assessment, monitoring, and management of infusion reactions can help minimize the risk of severe adverse events 8.