Single Donor Versus Acrodose Platelets in Oncology Patients: A Single Institutional Experience

INTRODUCTION:

Patients undergoing hematopoetic stem cell transplantation or myelosuppressive chemotherapy for solid and hematologic malignancies commonly develop thrombocytopenia requiring prophylactic platelet transfusions once their level falls below ten thousand. In our institution, the primary replacement product is single donor platelets. This is collected by an apheresis machine using only one donor and they also undergo processing and testing prior to transfusion which leads to higher hospital costs. 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. These platelets enhance patient safety with culture-based bacteria testing for whole blood derived platelets. Moreover, 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. They also have inline filtration systems capable of producing leukocyte reduced whole blood platelets and plasma. Each unit of Acrodose platelets contains pools of 4-6 units of lueko-reduced platelet concentrates in plasma. The purpose of this study is to evaluate platelet response and time to next transfusion in both leukemic and stem cell transplant patients between single donor and Acrodose platelet transfusions.

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 seventeen bone marrow transplant patients of which sixteen were autologous (seven had multiple myeloma, eight had Non-Hodgkin’s lymphoma and one had POEMS syndrome) and one was allogeneic for chronic lymphocytic leukemia. In addition, there were twenty 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 acute leukemia patients. That same effect was not see with the bone marrow transplant patients. The reason for this is unclear and more studies are needed.