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pathogen reduced platelets and pediatric patients


MOBB

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How is everyone feeling about pathogen reduced platelets and pediatric patients? I have yet to see a study done in the US. For those outside the US, have you seen any adverse effects from transfusing pathogen reduced products to pediatric patients?

Has anyone seen issues with patients allergic to celery, limes, figs or other foods that contain psoralens? 

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1 hour ago, MOBB said:

How is everyone feeling about pathogen reduced platelets and pediatric patients? I have yet to see a study done in the US. For those outside the US, have you seen any adverse effects from transfusing pathogen reduced products to pediatric patients?

Has anyone seen issues with patients allergic to celery, limes, figs or other foods that contain psoralens? 

None of which I know.

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I'm not aware of any data suggesting that psoralen treated platelets predispose to allergic reactions in adults, who are more likely to be atopic than children.  If one is concerned about the toxicity of platelet transfusions there are two major ways of reducing the toxicity (inflammation, impairment of platelet function, immunomodulation, organ failure, TRALI, TACO, febrile and allergic reactions).  The first is to always give ABO identical platelets and the second is to remove the supernatant prior to transfusion (e.g., washing).  Happy to provide references if anyone wants them.

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25 minutes ago, Neil Blumberg said:

I'm not aware of any data suggesting that psoralen treated platelets predispose to allergic reactions in adults, who are more likely to be atopic than children.  If one is concerned about the toxicity of platelet transfusions there are two major ways of reducing the toxicity (inflammation, impairment of platelet function, immunomodulation, organ failure, TRALI, TACO, febrile and allergic reactions).  The first is to always give ABO identical platelets and the second is to remove the supernatant prior to transfusion (e.g., washing).  Happy to provide references if anyone wants them.

I can see how always giving ABO identical platelets and washing off the supernatant would help reduce toxicity, but I am struggling to see how either, or both, of these procedures would mitigate against TACO in any way, as this (like it says on the tin) is to do with volume of component transfused and/or speed of transfusion?

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TACO is not just volume overload, contrary to conventional wisdom.  Half the patients considered to have TACO  have fever as well as signs of congestive heart failure/pulmonary dysfunction along with transfusion.  Thus it's clear that TACO has an inflammatory component in many or most patients, as well as problems in dealing with the water and protein volume.  It's  probably not terribly different from some cases of TRALI, which are

both antibody and cytokine/mediator in etiology.  These distinctions are more pedagogic/nosologic than physiologic/biologic, in my view.  In any case, a patient with functioning kidneys can rapidly excrete the salt and water that come with the crystalloid wash. The body has no mechanism for rapidly getting rid of the plasma protein infused with the typical platelet or plasma transfusion (about a quarter of a liter).  In about 100,000+ washed components we have yet to see a case of TACO or TRALI, granted the usual passive reporting (knock on wood).  When we instituted universal leukoreduction, reports of congestive heart failure signs and symptoms (TACO) dropped 50% and stayed there, and reports of TRALI dropped 80% (and stayed there).  That, amongst other data, tells me that both TACO and TRALI are mediated by immunologic mechanisms (other than antibody) that haven't been elucidated.

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Thanks for that Neil Blumberg; I was blissfully unaware of that data, and will make it my job to keep more up-to-date with matters "blood transfusion", as well as my own speciality of "blood group serology".  I read a paper recently (within the last year) on which you were a co-author concerning "minor" ABO-mismatches in transfusions, resulting in morbidity due, possibly/probably to immune complexes, and was very impressed.

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It would be so nice to have the luxury of giving, at least, ABO identical pltphs.  We really don't have that here, we have too few pltphs to choose from in this region.  And washed pltphs would have to cross state lines and our distribution system does not have them FDA licensed, so they don't get to come up here.   But thank you for the information - we can simply try harder. 

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