Impact of the Duration of Platelet Storage in Critically Ill Trauma Patients
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background There is increasing evidence that the duration of red blood cell RBC storage negatively impacts outcomes. Data regarding prolonged storage of other blood components, however, are lacking. The aim of this study was to evaluate how the duration of platelet storage affects trauma patient outcomes. Methods Trauma patients admitted to a Level I trauma center requiring platelet transfusion 2006 2009 were retrospectively identified. Apheresis platelets aPLT containing 3 x 10expn 11 plateletsunit were used exclusively. Patients were analyzed in three groups those who received only aPLT stored for 3 days, 4 days, and 5 days. The outcomes included mortality and complications sepsis, acute respiratory distress syndrome, renal, and liver failure. Results Three hundred eighty-one patients were available for analysis 128 received aPLT 3 days old 109 4 days old and 144 5 days old. There were no significant demographic differences between groups. Patients receiving aPLT aged 4 days had significantly higher Injury Severity Score p 0.022 and were more likely to have a head Abbreviated Injury Scale 3 p - 0.014. There were no differences in volumes transfused or age of RBC, plasma, cryoprecipitate, or factor VIIa. After adjusting for confounders, exposure to older aPLT did not impact mortality however, with increasing age, complications were significantly higher. The rate of sepsis, in particular, was significantly increased 5.5 for aPLT 3 days vs. 9.2 for aPLT 4 days vs. 16.7 for aPLT 5 days, adjusted p 0.033. For acute respiratory distress syndrome and renal and liver failure, similar trends were observed. Conclusions In critically ill trauma patients, there was a stepwise increase in complications, in particular sepsis, with exposure to progressively older platelets. Further evaluation of the underlying mechanism and methods for minimizing exposure to older platelets is warranted.
- Anatomy and Physiology
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