Impact of the duration of platelet storage in critically ill trauma patients

Kenji Inaba, Bernardino C. Branco, Peter Rhee, Lorne H. Blackbourne, John B. Holcomb, Philip C. Spinella, Ira Shulman, Janice Nelson, Demetrios Demetriades

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

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 × 10 platelets/unit 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). Result: 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.

Original languageEnglish (US)
Pages (from-to)1766-1773
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue number6
DOIs
StatePublished - Dec 1 2011

Keywords

  • Complications
  • Duration of storage
  • Outcome
  • Platelets
  • Sepsis
  • Transfusion
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Inaba, K., Branco, B. C., Rhee, P., Blackbourne, L. H., Holcomb, J. B., Spinella, P. C., Shulman, I., Nelson, J., & Demetriades, D. (2011). Impact of the duration of platelet storage in critically ill trauma patients. Journal of Trauma - Injury, Infection and Critical Care, 71(6), 1766-1773. https://doi.org/10.1097/TA.0b013e31823bdbf9