DAMPS and complement activation in platelet concentrates that induce adverse reactions in patients.

BACKGROUND: Patients with severe thrombocytopenia due to bone marrow failure and after chemotherapy are still treated with platelet transfusions. Platelet concentrates (PC) are associated with a high incidence of adverse reactions (AR). Platelet-derived damage-associated molecular patterns (DAMPS) and complement were proposed to play a role in the pathology of AR. STUDY DESIGN AND METHODS: Single donor apheresis platelet concentrates (SDA PCs) were produced in a regional setting of the French Blood Establishment. After transfusion samples were collected from PC and possible AR in patients were recorded. Platelet activation markers, High mobility group box 1 (HMGB1) and complement activation products (CAP) were measured. The correlation between platelet activation, and HMGB1 and complement activation was analyzed. RESULTS: A total of 56 PC were included in the study. 30 PC induced no AR, and 26 induced AR (Febrile non-hemolytic transfusion reaction n = 16; Atypical Allergic Transfusion Reactions n = 11; hemodynamic instability n = 5) in the patients. The levels of P-selectin, sCD40L, HMGB1, C3b/c, and C4b/c were all significantly increased in PC that induced AR following transfusion in patients. Additionally, HMGB1, C3b/c, and C4b/c were positively correlated with P-selectin and sCD40L. CONCLUSION: In this study, we observed an association between HMGB1 and CAP and the incidence of AR. Furthermore, we demonstrated that both HMGB1 and complement activation were correlated to platelet activation.

Adverse reactions to blood transfusion: A retrospective analysis of 750 cases in Wuxi area from 2017 to 2019 / 中国输血杂志

【Objective】 To explore the incidence of adverse reactions to blood transfusion in Wuxi, so as to provide theoretical basis for further improving the safety of blood transfusion in this area. 【Methods】 211 778 cases of blood transfusion in hospitals in Wuxi from 2017 to 2019 were collected, and the incidence of adverse reactions were retrospectively analyzed. 【Results】 From 2017 to 2019, 750 cases of adverse reactions occurred in Wuxi, with the incidence rate at 0.35%(750/211 778), which kept increasing year by year. The incidence of reactions relative to apheresis platelet transfusion was the highest, about 0.86% (accounting for 32.8%, 246/750), viral inactivated frozen plasma transfusion 0.1% (accounting for 30.4%, 228/750), showing an increasing trend year by year, suspension of leukocytes reduced RBC 0.12%(257/220 106), washed RBC 0.08%(5/6 439) and cryoprecipitate 0.02%(14/750) respectively (the above three accounting for 36.8%, 216/750). The adverse reactions were mainly allergic reactions (67.6%, 507/750) and febrile non-haemolytic transfusion reaction(FNHTR) (28.8%, 216/750), and the incidence of both increased year by year. In addition, there were 6 cases (0.8%, 6/750) of transfusion-associated circulation overload, 2 cases (0.27%, 2/750) of post transfusion purpura, 1 case (0.13%, 1/750) of transfusion-related acute lung injury and 18 miscellaneous cases (2.4%, 18/750). Further analysis revealed that red blood cell products were the main causes for FNHTR, and platelets and plasma products for allergic reactions. 【Conclusion】 The incidence of adverse reactions in Wuxi, mainly composed of allergic and febrile reactions caused by transfusions of blood components other than cryoprecipitate, was lower than the general level in China, but it kept increasing year by year. Measures should be taken by hospitals to strengthen the monitoring, reporting of adverse reactions, so as to prevent and further reduce the incidence of adverse reactions.