Routine Use of Platelet Components Prepared with Photochemical Treatment (INTERCEPT Platelets) : Impact on Clinical Outcomes and Costs.

Abstract

Background: In 2003 the Blood Transfusion Ctr (BTC), Cliniques Universitaires Mont Godinne (CU-MG) initiated routine use of INTERCEPT Platelets (I-P) for transfusion support of thrombocytopenia. To examine the impact of I-P on patient outcomes and costs, the rate of acute transfusion reactions (ATR) for platelet (PLT) and red cell (RBC) transfusions (txn) were compared for 285 days (d) before I-P adoption, when only conventional platelets (C-P) were used, and for 255 d after adoption of I-P for routine use. Since preparation of RBC did not change, the relative rates of PLT-ATR and RBC-ATR in the 2 periods were used to assess the impact of I-P on ATR.Methods: In both periods, PLT were collected on the Amicus Cell Separator (Baxter) with process leuko-reduction. For C-P, T-Sol (Baxter) with a ratio to plasma of ~ 70:30 % was used; and for I-P, Intersol (Baxter)with a ratio to plasma of ~ 65:35 % was used. I-P containing 2.5 to 6.0 x 1011 plts in ~ 300 mL were prepared with an integrated processing set using amotosalen (S-59, 150 uM) and UVA (3 J/cm2) to inactivate pathogens and leukocytes. As for C-P, I-P were issued the d after collection and were stored for up to 5 d. The Hematology Service reported PLT and RBC ATR (febrile and non-febrile ATR occurring within 24 hr of txn) to the BTC. HLA and PLT antibodies (AB+/AB−) were determined by the BTC in pts with suspected alloimmunization. Factors impacting costs for PLT, before and after adoption of I-P, were assessed by the BTC.Results: Days of observation before and after adoption of I-P were similar (Table). More pts received I-P, due to an increase of CV surgery pts after I-P adoption. The mean plt dose was 2% lower with I-P (4.06 vs 4.15 x 1011), and the number of PLT txn/pt was 8% higher for I-P. The rate of ATR to PLT txn with I-P showed a declining trend (p =0.08) , while the rate of ATR to RBC txn was similar in the 2 periods (p = 0.55). Before and after I-P, 16.5 and 9.3 % of pts receiving plt had PLT ATR, respectively. The decrease was largely due to fewer ATR in pts without AB detected (AB-). Adoption of I-P did not require addition of personnel to the BTC, nor delay time of PLT issue. I-P did not affect the number of plt donors required to support the CU-MG patient population. I-P replaced gamma irradiation for prevention of txn-associated GVHD and avoided use of routine bacterial testing for PLT.Conclusions: Use of I-P resulted in a trend of decreased incidence for ATR to PLT txn on a per txn and per pt basis compared to RBC ATR. The average dose of I-P was minimally lower than C-P, and the number of PLT txn/pt was slightly increased. Adoption of I-P did not adversely impact the cost of donor recruitment or donor utilization nor the cost of BTC personnel. I-P avoided the cost of gamma irradiation and routine bacterial cultures. I-P offer the potential to reduce patient care costs due to reduced ATR.Impact of I-P AdoptionComponentC-PC-RBCI-PC-RBCPeriodBeforeBeforeAfterAfterDays285285255255Patients103na129naHem-Onc47%na44%naCV Surgery35%na47%naTXN (units)1466511019904895ATR : No. TXN (%)23 (1.57%)18 (0.35%)18 (0.90%)21 (0.42%)AB+/AB-6/133/156/74/17TXN/Patient14.2na15.4nana = not available