Platelet Refractory Cases after Transfusion of Fresh and Stored Platelet in all Children

Abstract

Introduction: Acute leukemia is the most common form of cancer in children, platelet transfusion is needed for the chemotherapy of acute lymphoblastic leukaemia children. Platelets are transfused for therapeutic and prophylactic purposes. Transfusion of stored platelet concentrates (up to 5 days) has been demonstrated to be as effective as transfusion of fresh platelet concentrates (upto 24 hours). Platelet refractory cases were also observed in this study that was detected by Corrected Count Increment (CCI) and Percent Platelet Recovery (PPI) at 1hour and 24 hours. Aim of the study: The aim of this study was to observe the platelet refractory cases after transfusion of fresh and stored platelet in acute lymphoblastic leukemia (ALL) in a tertiary care hospital, Dhaka. Methods: A cross-sectional study was conducted in the Department of Clinical Pathology, Paediatric Haematolo- Oncology and transfusion Medicine BSMMU, Department of Haematology and Paediatric Haemato-Oncology in Dhaka Medical College Hospital from March 2010 to February 2011 where 81 children diagnosed with acute lymphoblastic leukaemia were taken as the study population. Non probability purposive sampling was used by fulfilling the inclusion criteria. Ethical consideration was taken by the BSMMU ethical review committee. A data sheet with two parts (Part A and Part B) was designed with a view to collect data from the patients to be enrolled in the study. Data were analyzed using the SPSS version 25.0. Results: Out of 81 in 47 children with acute lymphoblastic leukemia (ALL), fresh platelet concentrates (FPC) (upto 24 hours) or day-0 platelets were transfused. In 34 children, stored platelet concentrates (SPC) (days 1–5) were transfused. In 27 cases, platelet concentrates were transfused both fresh and stored. In FPC and SPC, the corrected count increment at one hour (CCI 1h) was 20.5×109/L and 18.9×109/L respectively. FPC and SPC values for the mean corrected count increment at 24 hours (CCI 24h) were 15.5×109/L and 13.8×109/L respectively. Platelet refractory cases were 15(18.5%) out of 81 cases transfused. Platelet refractory cases were 7(15%) out of 47 cases transfused with FPC and 8(23%) out of 34 cases transfused with stored platelet concentrate (SPC). There were no significant differences (P<0.05) between FPC and SPC according to platelet refractoriness. Conclusion: In vivo quality of freshly generated platelet (upto 24 hours) versus stored platelet concentrates (up to 5 days) were determined after 1 hour and 24 hours. 1-5 day’s stored PRP-PCs are as effective as fresh PRP-PCs for sufficient platelet increment.