Improving Platelet Transfusion: The Impacts of Pathogen Reduction Technology and Increased Storage Periods

Abstract

Removing, inactivating or detecting pathogens in platelet units are panaceas that some expect to revolutionize transfusion support for patients. Opting for transfusion without concern for the presence of pathogens may not be such a simple decision, however. The effect of pathogen reduction treatment may reduce platelet number and/or function. Clinical trials have documented that treated platelets provide effective hemostatic support for thrombocytopenic patients. However, platelets may need to be transfused in greater quantity, and thus the treatment technique may create a greater demand for the production of platelets through the supply system. Toxicologic concerns about the treatments must be addressed to ensure that there is net benefit for patients. Testing reported to date suggests that any residual compounds are at concentrations far below that associated with detectable toxicity, but the concept of transfusing a component containing even minute amounts of toxic substances may be unsettling to some. Detecting bacteria may remove the largest remaining infectious threat in platelet units and would leave platelets undamaged to function normally. This opens the option for extending the storage period of platelet units, but any extension of storage would be expected to be associated with a decrease in recovery and survival. To avoid continuing decrements with each proposed change in processing or storage, a new standard for efficacy has been proposed that would compare the recovery and survival of the platelet component to fresh platelets from the same donor. This standard appears useful and applicable in ensuring safe and efficacious platelets for transfusion. The question remains: Which direction is best for platelet recipients?