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The effect of variation in donor platelet function on transfusion outcome: a semi-randomised controlled trial

Anne M. Kelly, Stephen F. Garner, Theodora Foukaneli, Thomas R. Godec, Nina Herbert, Brennan C. Kahan, Alison Deary, Lekha Bakrania, Charlotte Llewelyn, Willem H. Ouwehand, Lorna M. Williamson and Rebecca A. Cardigan

Key points

  • There is a variation in platelet function between normal individuals and this function is consistent within the same individual over time.

  • The data from this study suggest that variation in donor platelet function does not affect the outcome of prophylactic transfusion.

Abstract

The effect of variation in platelet function in platelet donors on patient outcome following platelet transfusion is unknown. This trial assessed the hypothesis that platelets collected from donors with highly responsive platelets to agonists in vitro assessed by flow cytometry (high responder donors), are cleared more quickly from the circulation than those from low responder donors, resulting in lower platelet count increments following transfusion. This parallel group, semi-randomised double-blinded trial was conducted in a single UK centre. Eligible patients were those 16 or older with thrombocytopenia secondary to bone marrow failure, requiring prophylactic platelet transfusion. Patients were randomly assigned to receive a platelet donation from a high or low responder donor when both were available, or when only one type of platelet was available patients received that. Participants, investigators and those assessing outcomes were masked to group assignment. The primary endpoint was the platelet count increment 10-90 minutes following transfusion. Analysis was by intention-to-treat. Fifty one patients were assigned to receive platelets from low responder donors, and 49 from high responder donors (47 of which were randomised and 53 non-randomised). There was no significant difference in platelet count increment 10-90 minutes following transfusion in patients receiving platelets from high (mean 21.0 x109/L, 95% CI 4.9 to 37.2) or low (mean 23.3x109/L, 95% CI 7.8 to 38.9) responder donors (mean difference 2.3, 95%CI -1.1 to 5.7, p = 0.18). These results support the current policy of not selecting platelet donors on the basis of platelet function for prophylactic platelet transfusion.

  • Submitted January 23, 2017.
  • Accepted April 22, 2017.