Impact of blood products on platelet function in patients with traumatic injuries: a translation study

TY - JOUR

T1 - Impact of blood products on platelet function in patients with traumatic injuries

T2 - a translation study

AU - Henriksen, Hanne Hee

AU - Grand, Alexandra G.

AU - Viggers, Sandra

AU - Baer, Lisa A.

AU - Solbeck, Sacha

AU - Cotton, Bryan A.

AU - Matijevic, Nena

AU - Ostrowski, Sisse R.

AU - Stensballe, Jakob

AU - Fox, Erin E.

AU - Chen, Tzu An

AU - Holcomb, John B.

AU - Johansson, Pär I.

AU - Cardenas, Jessica C.

AU - Wade, Charles E.

PY - 2017/6/15

Y1 - 2017/6/15

N2 - Background Reductions in platelet (PLT) count and function are associated with poor outcomes in trauma patients. We proposed to determine if patients expected to receive blood products have a decrease in PLT function higher than expected based on the reduction in PLT count, and if the reduction in function could be associated with the donor plasma/supernatant received. Methods PLT count and function were measured on admission to the emergency department and intensive care unit in severely injured patients expected to receive a transfusion. PLT function was measured by Multiplate aggregometry in response to five agonists. Function was corrected for alterations in count. In vitro studies were conducted in the blood of normal subjects to assess the effect of dilutions with AB donor plasma on PLT function. Results Forty-six patients were enrolled, with 87% requiring a transfusion. Median Injury Severity Score was 23 (13, 29) and mortality 15%. PLT count and function were decreased from emergency department to intensive care unit admission by 25% and 58%, respectively. Decreases in function persisted after adjustment for count. Patients requiring large volumes of blood products had reductions in function that were disproportionately greater. Reductions in PLT function were greatest after transfusion of PLTs. In in vitro studies with a 30% dilution by autologous plasma caused a relational reduction in function, whereas allogenic plasma resulted in greater decreases that were highly variable between donors. Conclusions Within hours of injury a decrease in both PLT count and function occurs, that is aggravated with the administration of blood products, with transfusion of PLTs showing the greatest effect. The effect on PLT function of allogenic transfused plasma appears to be highly donor related.

AB - Background Reductions in platelet (PLT) count and function are associated with poor outcomes in trauma patients. We proposed to determine if patients expected to receive blood products have a decrease in PLT function higher than expected based on the reduction in PLT count, and if the reduction in function could be associated with the donor plasma/supernatant received. Methods PLT count and function were measured on admission to the emergency department and intensive care unit in severely injured patients expected to receive a transfusion. PLT function was measured by Multiplate aggregometry in response to five agonists. Function was corrected for alterations in count. In vitro studies were conducted in the blood of normal subjects to assess the effect of dilutions with AB donor plasma on PLT function. Results Forty-six patients were enrolled, with 87% requiring a transfusion. Median Injury Severity Score was 23 (13, 29) and mortality 15%. PLT count and function were decreased from emergency department to intensive care unit admission by 25% and 58%, respectively. Decreases in function persisted after adjustment for count. Patients requiring large volumes of blood products had reductions in function that were disproportionately greater. Reductions in PLT function were greatest after transfusion of PLTs. In in vitro studies with a 30% dilution by autologous plasma caused a relational reduction in function, whereas allogenic plasma resulted in greater decreases that were highly variable between donors. Conclusions Within hours of injury a decrease in both PLT count and function occurs, that is aggravated with the administration of blood products, with transfusion of PLTs showing the greatest effect. The effect on PLT function of allogenic transfused plasma appears to be highly donor related.

KW - Blood

KW - Patients

KW - Platelet

KW - Study

KW - Translation

KW - Trauma

U2 - 10.1016/j.jss.2017.02.037

DO - 10.1016/j.jss.2017.02.037

M3 - Journal article

C2 - 28624038

AN - SCOPUS:85017115110

SN - 0022-4804

VL - 214

SP - 154

EP - 161

JO - Journal of Surgical Research

JF - Journal of Surgical Research

ER -