BACKGROUND & AIMS:
:The respective use of random (RPC) and apheresis (APC) platelet concentrates is highly heterogeneous among countries, ranging from 10 to 98% RPC in countries supposed to provide a similar transfusion service to patients. Moreover, when considering each country in the past 10 years, one can observe that some have changed their policy, switching from a majority of APC to RPC or vice versa. This presentation intends to analyse which factors may impact such decisions. For many years, the only available platelet component was a RPC obtained from whole blood donation by a two centrifugation steps process, the "platelet rich plasma" or PRP method. Since the beginning of the 1970s, APCs became available, with in fact many different techniques leading to many APCs that may not be equivalent. Since the end of the 1980s, a new method of RPC preparation was developed, using the buffy-coat (BC-PC), providing a blood component with highly preserved platelet functions as compared to RPCs prepared by the PRP technique. Finally, the use of each of these components either native, or leuco-reduced, or suspended in a storage solution, or processed with a pathogen inactivation technique adds new layers of complexity to compare them. Innumerable references can be found in the literature describing in vitro functional parameters of platelet concentrates. Although it is clear that BC-RPC retain much more their in vitro functions than PRP-RPC, indicating that no one should use the latter any more, it is much more difficult to distinguish differences between other PCs. Conversely, only a very few studies have been published related to a comparison of clinical efficacy of RPC versus APC, the endpoints being mainly CCI. Similarly to the in vitro studies, although RPC prepared with the PRP method show the lowest CCIs, no clear difference exists between "modern" RPC and APC. Another factor that may impact policy decision is the occurrence of adverse reactions in recipients. When considering only comparable data, for example leuco-reduced RPC versus leuco-reduced APC, there is now evidence that the latter is more associated with adverse reactions in recipients: data from hemovigilance in France show that, although no difference is noted for febrile non haemolytic transfusion reactions, nor for bacteria contamination, the incidence of allergic adverse reactions is about four times higher with APC as compared with RPC. Other aspects may impact the decision: the fact that using APC in place of RPC reduces the total donor exposure of patients was considered critical in some countries to reduce the risk of transmission of blood transmissible disease. Finally, the cost of the components, much higher for APC may be considered.
背景与目标:
:随机(RPC)和单采血液(APC)血小板浓缩液的使用在各国之间是高度异质的,在应该向患者提供类似输血服务的国家中,RPC的使用范围从10%到98%不等。此外,在过去10年中考虑每个国家时,可以观察到一些国家改变了其政策,从大多数APC转换为RPC,反之亦然。本演示文稿旨在分析哪些因素可能影响此类决策。多年来,唯一可用的血小板成分是通过两个离心步骤过程(“富含血小板的血浆”或PRP方法)从全血中获得的RPC。自1970年代初以来,APC便已问世,实际上有许多不同的技术导致许多APC可能不等效。自1980年代末以来,使用血沉棕黄层(BC-PC)开发了一种新的RPC制备方法,与通过PRP技术制备的RPC相比,该血液组分具有高度保留的血小板功能。最后,使用这些天然成分或无色成分减少的成分,或悬浮在存储溶液中或使用病原体灭活技术处理的成分,都增加了新的复杂度来比较它们。在描述血小板浓缩物的体外功能参数的文献中可以找到无数的参考文献。尽管很明显BC-RPC比PRP-RPC保留了更多的体外功能,这表明没有人可以再使用PRP-RPC,但是要区分其他PC之间的差异要困难得多。相反,只有很少的研究发表过与RPC和APC的临床疗效比较相关的研究,其终点主要是CCI。与体外研究相似,尽管用PRP方法制备的RPC显示出最低的CCI,但“现代” RPC和APC之间没有明显的区别。可能影响政策决策的另一个因素是受助者中发生的不良反应。当仅考虑可比较的数据时,例如白细胞减少的RPC与白细胞减少的APC,现在有证据表明后者与接受者的不良反应相关:法国的血液警惕性数据表明,尽管对于发热性非酒精性脂肪性肝炎没有观察到差异。与RPC相比,APC的溶血性输血反应或细菌污染的变态反应性不良反应的发生率大约高四倍。其他方面可能会影响该决策:在某些国家,使用APC代替RPC可以减少患者的总供体暴露这一事实对于减少血液传播疾病的传播风险至关重要。最后,可以考虑组件的成本,对于APC而言,成本要高得多。