The Impact of Platelet Transfusion in Massively Transfused Trauma Patients

Abstract

Abstract : BACKGROUND: The impact of platelet transfusion in trauma patients undergoing a massive transfusion (MT) was evaluated. STUDY DESIGN: The Institutional Trauma Registry and Blood Bank Database at a Level I trauma center was used to identify all patients requiring an MT ( greater than or equal to 10 packed red blood cells [PRBC] within 24 hours of admission). Mortality was evaluated according to 4 apheresis platelet (aPLT):PRBC ratios: Low ratio (less than 1:18), medium ratio (greater than or equal to 1:18 and less than 1:12), high ratio (greater than or equal to 1:12 and less than 1:6), and highest ratio (greater than or equal to 1:6). RESULTS: Of 32,289 trauma patients, a total of 657 (2.0%) required an MT. At 24 hours, 171 patients (26.0%) received a low ratio, 77 (11.7%) a medium ratio, 249 (37.9%) a high ratio, and 160 (24.4%) the highest ratio of aPLT:PRBC. After correcting for differences between groups, the mortality at 24 hours increased in a stepwise fashion with decreasing aPLT:PRBC ratio. Using the highest ratio group as a reference, the adjusted relative risk of death was 1.67 (adjusted p = 0.054) for the high ratio group,2.28(adjusted p = 0.013)for the medium ratio group ,and 5.51 (adjusted p less than 0.001) for the low ratio group. A similar stepwise increase in mortality with decreasing platelet ratio was observed at 12 hours after admission and for overall survival to discharge. After stepwise logistic regression, a high aPLT:PRBC ratio (adjusted p less than 0.001) was independently associated with improved survival at 24 hours. CONCLUSIONS: For injured patients requiring a massive transfusion, as the apheresis platelet-to-red cell ratio increased, a stepwise improvement in survival was seen. Prospective evaluation of the role of platelet transfusion in massively transfused patients is warrand.