Abstract
BackgroundPlatelet component (PC) transfusion leads occasionally to inflammatory hazards. Certain BRMs that are secreted by the platelets themselves during storage may have some responsibility.Methodology/Principal FindingsFirst, we identified non-stochastic arrangements of platelet-secreted BRMs in platelet components that led to acute transfusion reactions (ATRs). These data provide formal clinical evidence that platelets generate secretion profiles under both sterile activation and pathological conditions. We next aimed to predict the risk of hazardous outcomes by establishing statistical models based on the associations of BRMs within the incriminated platelet components and using decision trees. We investigated a large (n = 65) series of ATRs after platelet component transfusions reported through a very homogenous system at one university hospital. Herein, we used a combination of clinical observations, ex vivo and in vitro investigations, and mathematical modeling systems. We calculated the statistical association of a large variety (n = 17) of cytokines, chemokines, and physiologically likely factors with acute inflammatory potential in patients presenting with severe hazards. We then generated an accident prediction model that proved to be dependent on the level (amount) of a given cytokine-like platelet product within the indicated component, e.g., soluble CD40-ligand (>289.5 pg/109 platelets), or the presence of another secreted factor (IL-13, >0). We further modeled the risk of the patient presenting either a febrile non-hemolytic transfusion reaction or an atypical allergic transfusion reaction, depending on the amount of the chemokine MIP-1α (<20.4 or >20.4 pg/109 platelets, respectively).Conclusions/SignificanceThis allows the modeling of a policy of risk prevention for severe inflammatory outcomes in PC transfusion.
Highlights
Transfusion is a safe process and leads to few adverse events (AEs), especially because systematic leukoreduction was implemented for all labile blood components (LBCs)
The study population The study population consisted of patients who received single donor apheresis (SDA)-Platelet component (PC) transfusions in the previous 3 years in a very homogeneous case observational study: one single blood establishment (BE) collected, processed, prepared, controlled, and transfused the PCs and contributed to the follow-up of the cases
The surveillance, of the transfused patients was conducted by one dedicated team of physicians in a single university hospital, who agreed to discuss the cases with the BE to harmonize the declaration of an AE in accordance with the national regulation in force
Summary
Transfusion is a safe process and leads to few adverse events (AEs), especially because systematic leukoreduction was implemented for all labile blood components (LBCs). There are evidence-based observations that the factors associated with stored platelets themselves play a significant role in those AEs, especially in the most severe ones, termed acute transfusion reactions (ATRs) [3,4,5]. This strategy allowed the identification of 14 relevant BRMs, with some being expected (such as sCD40L) and others not previously associated with platelets; it further allowed the creation of profiles of BRMs linked with clinical presentations; last, it permitted the establishment of predictive models of hazard outcome based on levels of sCD40L, IL-13, and MIP-1a This approach, combining clinical reports, biological data, and mathematical/statistical models, is original and may help develop predictive tests to prevent the transfusion of possibly harmful PCs, especially in fragile patients unable to cope with inflammatory conditions. Certain BRMs that are secreted by the platelets themselves during storage may have some responsibility
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