Blood banks fill a critical need for supplying blood and platelets to hospitals and health care systems around the world. However, there is a major leak in this supply chain in terms of classification and quality control that many blood banks unknowingly propagate: the delivery of activated platelets.
Platelets that are delivered to hospitals and health care systems have 2 primary intended purposes: prophylaxis or therapeutic treatment for patients with thrombocytopenia due to chemotherapy or hematopoietic stem cell transplant (HSCT) and prophylaxis for surgery or trauma to assist with clotting in patients with thrombocytopenia.1 Upon delivery, these platelets are assumed to be nonactivated, or resting. Resting platelets retain their discoid shape and can be life-saving for the most vulnerable patients. However, a significant percentage of these platelets are activated, meaning they have changed to a more amorphous form through natural processes.
Unpublished data have shown that 30% to 50% of all platelet transfusions in hospital inventory contain activated platelets. Whether platelets are activated or resting can have major health and cost implications, particularly for hematologic and oncologic patients and their care teams. Results from a meta-analysis involving 4 hospitals and 471 patients who had no prior documented platelet transfusions demonstrated that in these patients, transfusions of activated platelets were more likely to result in reduced platelet count increments and shorter intervals between transfusions compared with resting platelets.2 The number of transfusions more than doubled after receiving just 1 transfusion of activated platelets, and patients receiving a transfusion of activated platelets typically received 6 subsequent transfusions compared with only 2 subsequent tranfusions in patients receiving resting platelets. In other words, a transfusion of activated platelets increased the future transfusion requirement by 4.
Platelet refractoriness is typically defined as 2 or more consecutive unsuccessful platelet transfusions or persistent thrombocytopenia despite transfusion. An estimated 15% to 35% of prophylactic platelet recipients become refractory. When patients exclusively received resting platelets, a significant reduction in average transfusions per patient was observed.3-5
Peer-reviewed, published research has demonstrated that pediatric hematologic and oncologic patients as well as adults with acute myeloid leukemia (AML) experience poorer health outcomes and worse financial outcomes when they receive activated platelets. Among pediatric patients who underwent an 88-day quality improvement initiative, receiving a transfusion of activated platelets led to a decrease in count increments of 24% and a decrease in time to next transfusion of 25% (almost a full day). Conversely, when infused with resting platelets, complex pediatric patients received 71% fewer transfusions and overall pediatric transfusions reduced by 44%. This translated to more than $700,000 in projected annual savings.6-8
Among adults with AML who underwent a 100-day quality improvement initiative, receiving a transfusion of activated platelets led to count increments decreasing by 22% and time to next transfusion decreasing by 24%. Among adults with AML transfused with resting platelets, there was an 88% reduction of complex cases and a 43% reduction in the number of transfusions per patient, with projected annual savings of more than $3.7 million.6,7