METHODS AIMED AT REDUCING THE RESIDUAL RISK OF PATHOGEN TRANSMISSION DURING PLATELET TRANSFUSION: A LITERATURE REVIEW
Keywords:
Blood Platelets, Platelet Transfusion, Platelet Transfusionmethods*, Riboflavin, Ultraviolet Rays, Photosensitizing Agents, Platelet Transfusionadverse effectsAbstract
Objective: In the Brazilian public health system, sterile filtration is often used to prevent infections associated with platelet transfusion. The literature addressing this issue indicates that pathogen inactivation could be incorporated as an alternative to the development of individual tests and blood donor selection. The objective was to assess whether the use of platelets submitted to pathogen inactivation by photochemical methods could decrease the incidence of post-transfusion infections by viruses, bacteria or other pathogens compared to the use of platelet concentrate or platelets extracted by apheresis without photochemical treatment.
Methods: A literature review from 1998 to 2015 was conducted. The scientific literature was surveyed using six electronic databases, two Internet search tools and a manual search of references, using specific search strategies for each database. The selected studies were assessed for quality according to a specific methodology. Data analysis was performed by observations made from the efficacy of the methods.
Results: From a detailed analysis of 426 articles retrieved, 10 articles were selected for this review. Among the selected studies, seven studies were clinical trials, and three studies were systematic reviews in combination with meta-analysis. The outcomes analyzed included the reduction of the residual risk in pathogen transmission, mortality, occurrence of hemorrhagic events, corrected count increment (CCI) after 1 h, CCI after 24 h, and transfusion reactions.
Conclusion: Differences were found in the quality of the included studies. Systematic reviews conducted on this topic, in alliance with political, social and administrative factors, will aid decision makers regarding its incorporation into the Brazilian Health System.
Keywords: Blood Platelets, Platelet Transfusion, Platelet Transfusion/methods*, Riboflavin, Ultraviolet Rays, Photosensitizing Agents, Platelet Transfusion/adverse effects
Downloads
References
World Health Organization. The Clinical Use of Blood in Medicine, Obstetrics, Paediatrics, Surgery and Anaesthesia, Trauma and Burns. Geneva; 2003. p. 372.
Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Especializada. Guide to use of blood products. Available from: http://bvsms.saude.gov.br/bvs/ publicacoes/guia_uso_hemocomponentes.pdf. [Last accessed on 14 Oct 2015].
Brasil. Agência Nacional de Vigilância Sanitária; 2014. p. 39.
Patil US, Jaydeokar AV, Bandawane DD. Immunomodulators: a pharmacological review. Int J Pharm Pharm Sci 2012;4:30–6.
Klamroth R, Gröner A, Simon TL. Pathogen inactivation and removal methods for plasma-derived clotting factor concentrates. Transfusion 2014;54:1406–17.
Allain JP, Bianco C, Blajchman MA, Brecher ME, Busch M, Leiby D, et al. Protecting the blood supply from emerging pathogens: the role of pathogen inactivation. Transfus Med Rev 2005;19:110–26.
Allain JP, Stramer SL, Carneiro-Proietti ABF, Martins ML, Lopes da Silva SN, Ribeiro M, et al. Transfusion-transmitted infectious diseases. Biologicals 2009;37:71–7.
Kaiser-Guignard J, Canellini G, Lion N, Abonnenc M, Osselaer JC, Tissot JD. The clinical and biological impact of new pathogen inactivation technologies on platelet concentrates. Blood Rev 2014;28:235–41.
Oxford Centre for Evidence-based Medicine. Levels of Evidence. Available from: http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009. [Last accessed on 28 Sep 2015].
Janetzko K, Cazenave JP, Klüter H, Kientz D, Michel M, Beris P, et al. Therapeutic efficacy and safety of photochemically treated apheresis platelets processed with an optimized integrated set. Transfusion 2005;45:1443–52.
Lozano M, Knutson F, Tardivel R, Cid J, Maymó RM, Löf H, et al. A multi-centre study of therapeutic efficacy and safety of platelet components treated with amotosalen and ultraviolet A pathogen inactivation stored for 6 or 7 d prior to transfusion. Br J Haematol 2011;153:393–401.
McCullough J, Vesole DH, Benjamin RJ, Slichter SJ, Pineda A, Snyder E, et al. Therapeutic efficacy and safety of platelets treated with a photochemical process for pathogen inactivation: the SPRINT Trial. Blood 2004;104:1534–41.
Simonsen AC, Johansson PI, Conlan MG, Jacquet M, Lin JS, Junge K, et al. Transfusion of 7-day-old amotosalen photochemically treated buffy coat platelets to patients with thrombocytopenia: a pilot study. Transfusion 2006;46:424–33.
Slichter SJ, Raife TJ, Davis K, Rheinschmidt M, Buchholz DH, Corash L, et al. Platelets photochemically treated with amotosalen HCl and ultraviolet A light correct prolonged bleeding times in patients with thrombocytopenia. Transfusion 2006;46:731–40.
Van Rhenen D, Gulliksson H, Cazenave JP, Pamphilon D, Ljungman P, Klüter H, et al. Transfusion of pooled buffy coat platelet components prepared with photochemical pathogen inactivation treatment: the euroSPRITE trial. Blood 2003;101:2426–33.
Butler C, Doree C, Estcourt LJ, Trivella M, Hopewell S, Brunskill SJ, et al. Pathogen-reduced platelets for the prevention of bleeding. Cochrane Database of Systematic Reviews; 2013.
Cid J, Escolar G, Lozano M. Therapeutic efficacy of platelet components treated with amotosalen and ultraviolet a pathogen inactivation method: results of a meta-analysis of randomized controlled trials. Vox Sang 2012;103:322–30.
Vamvakas EC. Meta-analysis of the randomized controlled trials of the hemostatic efficacy and capacity of pathogen-reduced platelets. Transfusion 2011;51:1058–71.
Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Controlled Clin Trials 1996;17:1–12.
Cazenave JP, Folléa G, Bardiaux L, Boiron JM, Lafeuillade B, Debost M, et al. A randomized controlled clinical trial evaluating the performance and safety of platelets treated with MIRASOL pathogen reduction technology. Transfusion 2010;50:2362–75.