[Comparative study on platelet transfusion in Lorraine-Champagne and Alsace in 2015]. / Étude comparative des transfusions de concentrés plaquettaires en Alsace et en Lorraine-Champagne en 2015.

OBJECTIVES: To find explanations for the observed differences of platelets concentrates (PC) deliveries between 2 French regions, Lorraine-Champagne (LOCH) and Alsace (ALSA). METHODS: This is a non-interventional prospective study, performed during 30 days in 2015 in intensive care, cardiovascular surgery and onco-hematological wards of 8 LOCH and ALSA hospitals. Questionnaires listing clinical and biological parameters were attached to the prescription forms and filled in at each PC prescription. RESULTS: In all, 290 patients, 1093 prescriptions and 1093 deliveries of PC were analyzed. The pre-transfusional context (patient weight, prophylactic or curative situation, pre-transfusional platelet count) were homogenous. The phasing of the prescription forms wording had a direct impact on the doses' formulation : 100 % of the LOCH forms were expressed in platelet quantity (PQ), vs 22 % in ALSA. The mean interval between 2 transfusions was 2.9 days in ALSA vs 4.9 days in LOCH. The mean PQ/delivery was higher in ALSA (5.6.1011 vs 4.0.1011 in LOCH). The delivered PQs were compared to the 2003 French recommendations that were in force in 2015. Twenty-seven percent of the LOCH delivered PQs were in the recommended interval, vs Forty-nine percent in ALSA. Due to the systematic delivery of a single PC unit, including weights>80Kg, LOCH presented 63 % insufficient PQ deliveries. Twenty-two percent of the deliveries in ALSA were over the recommended interval, mostly linked with the simultaneous delivery of a second PC. CONCLUSION: This study identifies disparities in terms of prescription and delivery between LOCH and ALSA, which may explain their respective PC consumption levels.

[Adaptation of platelet concentrates delivery to HAS/ANSM requirements evolution in EFS Grand-Est]. / Adaptation de la délivrance des concentrés plaquettaires aux recommandations HAS/ANSM 2015 à l'EFS Grand-Est.

Evolution of French HAS/ANSM guidelines in 2015 about optimal platelet transfusion dose for patients brought us to review about our practices for platelet concentrates delivery in EFS Grand-Est region. In addition, pathogen inactivation in platelet concentrates has been implemented all over the country and transfusion centers have merged. All these changes required harmonization. In this context, our major issue was to answer patient's requirements, according to the new guidelines keeping in mind the cost effectiveness on public finances. We report here on the changes in our practices and their impacts.

Treatment of platelet concentrates and plasma with riboflavin and UV light: Impact in bacterial reduction.

OBJECTIVES: Transfusion of hemocomponents is essential for clinical and surgical procedures and therefore their safety has increased. An option for pathogen reduction includes the combination of riboflavin and UV light. To our knowledge, there are no studies in Latin America that demonstrate the effectiveness of the pathogen reduction in hemocomponents. The objective of this work was to evaluate the efficiency of a pathogens reduction system in platelets concentrates (PC) and plasma. MATERIALS AND METHODS: PC and plasma were contaminated with Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Staphylococcus epidermidis at 104 to 106 CFU and subjected to bacterial reduction. After bacterial reduction, hemocomponents were subjected to cultivation of surviving bacteria by automated method and classical colonies quantification. Additionally, quality control testing was performed in order to confirm the integrity of platelets and coagulation laboratory values in plasma before and after bacterial reduction. RESULTS: The bacterial death in PC/plasma was expressed by Logarithmic Reduction Value as follows: for both strains (E. coli and S. pyogenes) 4/4, 5/5 and 6/6; for K. pneumoniae 2.54/2.23, 2.94/2.22 and 3.44/2.98, for S. epidermidis 4/4, 3.11/5 and 3.23/4.19, for 104, 105 and 106 CFU, respectively. In PC and plasma, platelet count, pH (at 22°C), activated partial thromboplastin time (aPTT), prothrombin time (PT), fibrinogen, factor VIII and total proteins (TP) were slightly modified. CONCLUSIONS: UV light with riboflavin is able to reduce an important number of pathogens in hemocomponents; however, the bacterial reduction is influenced by the nature and quantity of the pathogen.

Pathogen inactivation/reduction technologies for platelet transfusion: Where do we stand?

Pathogen inactivation or reduction technologies for platelet components have been proposed to secure the microbial safety of this component, and particularly the microbial contamination. Transfusion-transmitted bacterial infections were substantially reduced by additive steps applied at different levels of the transfusion chain, but still killed one recipient each year or every other year in a country like France. Besides, pathogen inactivation and reduction stand for eliminating most viral and protozoa infections persisting in the separated blood component. In addition, because those processes attack nucleic acids, they also aim at substantially alleviating the risk of Transfusion Associates Graft versus Host Disease, as they attack lymphocytes still comprises within the component. Meanwhile, pathogen inactivation or reduction may inflict some damages to the platelet components, that are shown to be additive to the "natural" storage lesions linked to ageing. While it is in general assumed that such processes do not expose transfused patients to an over-risk of bleeding, and are safe, this does not mean that there are no detrimental consequences in the patients, even if not ascribed to as serious. Two such effects are now discussed or debated: the first one is the possible increase in the demand of platelet component, and the other one could be a possible risk of alloimmunisation especially when treated platelets are aged (over 5 days). Three processes have been made available by the industry, that differ in their chemical and physical (ultraviolet light illumination) characteristics. Two processes are largely used (one nationwide in two European countries) and the third one is still under clinical evaluation. This short review endeavored to critically present the main features of the processes and of their implementation.

Prevalence of bacterial contamination in platelet concentrates at the National Center of Blood Transfusion (Mexico).

OBJECTIVES: Most common bacterial sepsis associated with transfusion is caused by contaminated Platelet Concentrates (PC). The screening of PC to detect bacterial contamination is obligatory in Mexico, and it is carried out in quality control programs. In Mexico, the identification and molecular characterization of bacterial contaminants to detect contamination sources have not been implemented due to high costs; however, it is an actual current need. MATERIAL AND METHODS: One hundred PC were randomly selected and microbiologically analyzed. This sample size corresponds to 1% of the PC obtained by the National Center of Blood Transfusion (NCBT) in Mexico City according to the Official Mexican Standard NOM-253-SSA1-2012. Additionally, molecular biology tests were implemented in order to identify the possible contamination sources. RESULTS: Nine of the 100 PC analyzed (9%) showed bacterial contamination; analysis of the nucleotide sequences revealed the presence of characteristic microbiota from donor skin and soil. Diverse clonal relationship between the strains was identified in Staphylococcus epidermidis. CONCLUSION: Detection of contaminants associated with environmental and skin flora, shows the need to implement measures in the process of disinfecting skin at the site of phlebotomy and cleaning each of the areas involved in blood collection.

[Feasibility study for Intercept platelets]. / Étude de faisabilité des plaquettes Intercept.

During 3 months, platelet concentrates prepared by "Établissement français du sang Pyrénées-Méditerranée" (Blood bank) were treated with the Intercept process (CERUS©). This study primarily aimed to measure the organizational impact of this technology on transfusion chain. The introduction of Intercept did not raise any major difficulties, but required some adaptations upstream from the deployment. Prior information of health care institutions and physician was essential to anticipate the practical changes, including the prescription of platelet concentrates (CMV negative, irradiation). This study allowed to analyze also the transfusion consequences for patients, in the form of observational studies. The patients transfused with platelet concentrates treated with Intercept received more platelet concentrates (+12.9%), less rich in platelets (-12.8%), the cumulated quantity of platelet being stable.