Elsevier

Human Immunology

Volume 67, Issue 6, June 2006, Pages 413-418
Human Immunology

Platelet Transfusion Therapy: From 1973 to 2005

https://doi.org/10.1016/j.humimm.2006.03.005Get rights and content

Abstract

Platelet transfusions are indispensable for supportive care of patients with hematological diseases. We describe the developments in platelet products for transfusion since the 1970s, when, in particular, support for patients with allo-antibodies against human leukocyte antigens was a laborious exercise with a high failure rate. Currently, due to many stepwise innovations, platelet transfusions are of low immunogenicity and sufficiently available, they have a shelf life up to 7 days, and even matched platelets can often be routinely delivered, provided that there is good communication between all partners in the chain. Future improvements can be expected from uniform type and screen approaches for immunized patients and cross-matching by computer. For efficient use of health care resources, blood banks and stem cell donor banks could share their typed donor files.

Introduction

We used to have an evening report, where the daily transfusion problems were discussed. It was 1973. We were Jon van Rood, chairman of the Department of ImmunoHaematology and Blood bank (IHB), and, opening the wine bottle to keep our attention, George Eernisse (the director of the Blood bank), Hans Bruning (chemist and validating our “Coombs” sera), several physicians doing HLA research, often as replacement for the military service, and me, just arrived fellow in transfusion medicine. Apart from an incidental autoimmune hemolytic anemia, which we proudly classified with the sera (antigamma and antinongamma) produced by our own rabbits in the cage at the back of the Blood bank, bleeding dominated the report: bleeding from all causes and requiring different solutions. For hemophilia patients the Blood bank prepared cryoprecipitate, which needed quick cooling of citrated plasma. Heart surgery for children had come of age, requiring fresh blood and platelet transfusions to prevent bleeding. A bone marrow transplant program for aplastic anemia had begun [1] and the preparation of on-demand platelets (platelets had no shelf life) did not comply with the other bleeding problems to be solved by our small Blood bank. Moreover, the multitransfused aplastic anemia patients soon developed chills, fever, and no increment on repeated platelet transfusions. We heavily relied on our few HLA-typed donors, who were subjected to manual plateletpheresis, and in emergency situations we always turned to our few donors homozygous for common HLA types [1]. It was shameful to call them so often. Jon used to have at least one brilliant problem-solving plan at every evening report, which we tried to forget, because most of us already had a plan. But this was a persistent plan, the Euro platelet plan, coming down to type as many donors as possible, select HLA-homozygous donors and freeze the platelets. As a newcomer, I did not yet have a plan and it became obviously my problem.

In 1973 we could not foretell that in 2005 the physician in charge of the hematology/transplant ward on the morning round orders platelet transfusions by just marking a cross on the transfusion request chart, choosing from random, HLA-matched, concentrated, washed, cytomegalovirus-sero-negative, irradiated platelets. The story is as follows.

Section snippets

Leukodepletion: 1974–1980

For patients with febrile transfusion reactions, the Central Laboratory of the Dutch Red Cross developed in 1972 a cotton-wool filter to remove leukocytes from fresh (less than 24 hours old) citrated blood or red cells [2]. In 1974 we attended a lecture on the clinical results with these filtered transfusions in dialysis patients, who not only suffered no febrile transfusion reactions but, remarkably, also developed fewer leukocyte antibodies despite the fact that 30% of the platelets were

Cryopreservation of Platelets: 1973–1977

This part of the Europlatelet project was the first to come to a dead end. Using a final dimethyl sulfoxide concentration of 5% we sequentially compared the 51Cr recovery and survival of fresh and cryopreserved platelets from the same HLA-matched donor in 20 thrombocytopenic patients. If we calculated the ratio of the recovery of frozen platelets compared to fresh platelets these varied between 14 and 93% (median 45%). Also in three volunteers we observed unexplained variation of the frozen to

Technical Innovations (Platelet Filters, Sterile Connecting Devices, and Storage Bags): 1980–1995

The technology of leukocyte removal from platelets lagged ten years behind filtration of red cells, but the first results became available in 1983 [9], followed by generations of ever-improving leukocyte removal filters manufactured by several companies. For filtration of cells, however, the closed bag system had to be opened, limiting the shelf life of fresh filtered red cells to 24 hours and that of platelets, stored at room temperature, to 6 hours. In the 1980s the FDA approved the sterile

HLA Typing of Donors: 1973–2005

From 1973 onward, simultaneous with every otherwise indicated HLA typing session, a few extra donors were HLA typed. We selected these donors by checking all the (paper) donor files. Donors who uneventfully gave blood at least three times, had not been involved in a hepatitis case, and had not a profession that according to our view could lead to noncompliance with frequent platelet apheresis were chosen. HLA-homozygous donors were asked to participate in plateletpheresis. Later we asked formal

Assays to Detect Platelet Antibodies: Never-Ending Story

Based on the results of more than 1500 platelet transfusions to alloimmunized patients, Duquesnoy validated HLA matching for platelet donor selection [21]. The matching could be distinguished in increasing degrees of mismatches. In case of an A degree match, in which the donor carries no HLA-A and -B antigens incompatible with the patient (four antigens compatible), a B1 match (three antigens matched, one blank/unknown (U) or (X) cross-reactive), or a B2 match (two antigens matched, two either

Platelet Transfusion Therapy: 2005 and Beyond

The story of platelet supportive care illustrates that future predictions are generally wrong and that progress comes by many small steps and from various sides. But there remain new and old questions to be solved. Looking back, the achievements are great, so great that we presumably use too many inappropriate platelet transfusions, and preventive versus therapeutic indication for platelet transfusions becomes a new future question. Although we have horrifying memories of bleeding patients back

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