(P-TS-76) Pathogen-reduced (PR) vs. non-PR platelet usage and transfusion reactions on a pediatric hematology-oncology ward

Pathogen-reduced (PR) platelets have been introduced in clinical transfusion with the scope of preventing transfusion-transmitted infection (TTI). Platelet usage and transfusion reactions (TR) (other than sepsis) have not been fully characterized for PR vs conventional platelet transfusions. This study evaluates the platelet usage and incidence of TR before and after implementation of our PR platelet program.

Study

Design/Methods: This is a single-center retrospective cohort study where platelet usage was evaluated in two separate years:  a year prior to implementation of PR platelets (2017) and the most recent year (2023) after transition to nearly 100% PR platelets. The platelet usage was investigated amongst pediatric hematology-oncology inpatients and the following variables were collected: number of patients, age, gender, number of platelet transfusions, type of platelet products, and TR subtype. Statistical analysis was performed using Fisher exact test using Python with p< 0.05 considered to be statistically significant.

Results/Findings:

In our cohort, there were 133 patients in 2017 (age: 2-months to 29 years avg: 9.16 years; male 57%, female 43%), who received 1622 platelet transfusions (average 12.19/patient) on the pediatric hematology-oncology ward. In 2023, 114 patients (age: 2-month to 26-years, avg: 10.34 years; male 54%, female 46%) received 1211 platelet transfusions in the same location. In 2017, the inventory consisted of 6% PR and 94% non-PR platelets (66% with platelet additive solution [PAS] and 30% non-PAS), whereas in 2023, 99.9% were PR (99% with PAS and 0.9% non-PAS of all the transfusions). There were 29 platelet-associated TRs in 2017 (18 TR/1000 transfusions): 44.8% mild allergic reaction (MAR), 44.8% febrile non-hemolytic transfusion reaction (FNHTR), 7% severe allergic reaction (SAR), and 3.4% TTI due to Klebsiella sp. resulting in fatality.  In 2023, there were 25 TRs (~21 TR/1000 transfusions): 44% MAR, 36% FNHTR, 8% transfusion-associated dyspnea (TAD), 4% SAR, 4% transfusion-associated circulatory overload (TACO), and 4% acute hemolytic reaction (AHTR). There was no statistically significant difference between the two groups in the number of transfusions and various TR types (p >0.05 for all).

Conclusions:

PR inventory was not associated with increased platelet utilization in the studied pediatric hematology-oncology inpatient population. The incidence and types of platelet-associated TR were slightly different in the PR vs non-PR groups, however not statistically significant. One TTI resulting in fatality was associated with non-PR platelets.