Single Donor Vs. Acrodose Platelets in Oncology Patients: A Single Institutional Experience

ABSTRACT:

Patients undergoing hematopoetic stem cell transplantation or myelosuppressive chemotherapy for solid and hematologic malignancies have the propensity to develop thrombocytopenia to the point where they will require prophylactic platelet transfusions once their level falls below ten thousand.  In our institution, the primary replacement product is single donor platelets.  Recently, there has been the advent of Acrodose platelets which are obtained from whole blood.  These platelets are leuko-reduced, ABO matched, pooled and bacteria tested making them "transfusion ready" for the hospital.  It lowers handling costs at the hospital by eliminating the need for pooling and bacterial testing at the hospital.  The Acrodose system can detect >1 CFU/ml of bacteria at a rate of 99.3% thus reducing the risks of false positives.  Each unit of Acrodose platelets contains pools of 4-6 units of leuko-reduced platelet concentrates in plasma. 

METHODS:

Data was collected from October 2012 to October 2013.  There were a total of 349 platelet transfusions given, 61 were Acrodose and 288 were single donor.  There were 17 bone marrow transplant patients of which 16 were autologous (7 had multiple myeloma, 8 had Non-Hodgkin’s lymphoma and 1 had POEMS syndrome) and 1 was allogeneic for chronic lymphocytic leukemia.  In addition, there were 20 acute leukemia patients.  The bone marrow transplant patients received a total of 45 platelet transfusions of which 37 were single donor and 8 were Acrodose.  The acute leukemia patients received a total of 150 platelet transfusions of which 17 were Acrodose and 133 were single donor.   

RESULTS:

The average increase among all patients receiving Acrodose versus single donor platelets was 28.9 versus 19.8, respectively.  The median increase for Acrodose versus single donor was 28 versus 16.  The median time to next transfusion for Acrodose versus single donor was 4 versus 2 days.  In subgroup analysis, the average increase among bone marrow transplant patients receiving Acrodose versus single donor platelets was 21.7 versus 27.8, respectively.  The median increase for Acrodose versus single donor was 18 versus 20.  The median time to next transfusion for Acrodose versus single donor was the same at 3 days.  Among acute leukemia patients, the average increase in patients receiving Acrodose versus single donor platelets was 28 versus 18.6, respectively.  The median increase for Acrodose versus single donor was 27 versus 15.  The median time to next transfusion for Acrodose versus single donor was 4 versus 2 days.

CONCLUSION:

In our single institutional experience, Acodose platelets induced a more robust response and increased the time to next transfusion compared to single donor platelets among all patients and especially acute leukemia patients, however this was not seen with the bone marrow transplant patients.  The reason for this is unclear and more studies needs to be done.