Platelet transfusion practice after partial implementation of pathogen reduction during the COVID-19 pandemic in the Radom city and Mazowian Voivodeship region

ABSTRACT

Background: The Radom Regional Blood Transfusion Center supports hospitals in the Radom Region and southern Masovian voivodeship. During the COVID-19 pandemic, pathogen reduction (PR) was introduced for the treatment of COVID-19 convalescent plasma (CCP) to reduce the risk of window-period viral transmission. Subsequently PR was expanded to the treatment of apheresis platelets to reduce the risk of transfusion-transmitted infections. From May 26th, 2021, PRplatelets were issued in addition to conventional platelets to assess the acceptance and tolerability of PR-platelets. Aims: To assess transfusion practice after the introduction of PRplatelets and identification of the most exposed patient groups benefitting most from PR-platelets. Methods: Apheresis platelets collected with a Trima device (Terumo BCT) or an Amicus device (Fresenius Kabi) in 65% T-PAS+ (Terumo BCT) and 35% plasma or in 100% plasma and pooled buffy coat platelets in 65% T-PAS+ and 35% plasma or 100% plasma were issued in the Radom Region and southern Masovian voivodeship on demand with a minimum dose of 3 ± 1011 platelets/unit (platelet dose was assessed regularly for quality control). 18.9% of the platelet units (apheresis platelets in 100% plasma or 65% T-PAS+ and 35% plasma) were pathogen reduced (INTERCEPT Blood System, Cerus). Platelet transfusion reports from 16 hospitals in the Radom City and southern Masovian voivodeship between May 1st, 2021 and January 31st, 2022 were collected and analysed for transfusion frequency (platelet concentrates per patient) in four patient groups (haematology, oncology, COVID-19, other). Since COVID 19 appeared as a new indication, that patient group was analysed separately from the 'other' group to assess the transfusion practice. Statistical analysis was performed with the two-sample t-test. Results: The median age of all transfused patients was 65 years (14- 91), it was elevated in the haematology (70 years [24-91]) and COVID-19 (70 years [62-79]) patient groups. 28.2% of transfused platelets in the haematology patient group were PR, 13.7% in the other, 13% in the oncology and 0% in the COVID-19 patient group. The median number of transfusions received per patient (n = 164) was 2 (1-26). For haematology patients (n = 31) it was 9 (1-26), oncology (n = 24) 2 (1-8), COVID-19 (n = 6) 2 (2-11) and other (n = 103) 2 (1-12). The average platelet dose per unit was 3.4 ± 1011 ± 0.4 for all platelet units, 3.4 ± 1011 ± 0.4 for conventional platelets (n = 525) and 3.3 ± 1011 ± 0.3 for PR-platelets (n = 99), p > 0.05. There was also so significant difference in average platelet dose/unit between the different indication groups (p > 0.05). No unexpected adverse events were reported during the analysis time. Summary/Conclusions: The newly emerging COVID-19 patient group had a comparable platelet transfusion rate to the non-haematology/ oncology patient group. The patients belonging to the haematology group had the highest exposure to platelet transfusion with an increased risk for transfusion-transmitted infections and a high median age. 48% of patients in that group received 10 or more platelet transfusions. An increase of PR-platelet production to 50% would be needed to have sufficient PR-platelets support that vulnerable group. There was no significant difference in platelet dose between PR-platelets and conventional platelets.