Effect of platelet storage duration on platelet increment and clinical outcomes in critically ill patients - a randomised controlled trial

Background and objectives: Platelet storage duration may influence transfusion effectiveness and patient outcomes.The present study aimed to evaluate the effect of platelet storage duration on platelet increment and clinical outcomes in patients admitted to the intensive care unit (ICU).

Material and methods: This prospective, open-label, randomized controlled trial, conducted at a single centre, enrolled ICU patients requiring platelet transfusion. Patients were randomly assigned to receive platelet concentrates aged ≤3 days (Group 1) or 4-5 days (Group 2). Platelet increments were assessed by Absolute Platelet Count Increment (ACI), Corrected Count Increment (CCI), and Percentage Platelet Recovery (PPR). Clinical outcomes including bleeding, infection rates, ICU stay, red cell transfusion requirements, and mortality were also monitored.

Results: Patients transfused fresher platelets (Group 1) had higher median ACI, CCI and PPR at 1 hour compared to those transfused older platelets (Group 2) though the difference was not statistically significant.At 24 hours, Group 1 patients had a median ACI of 28,000/µl compared to 14,000/µl in Group 2(p = 0.001). The median CCI was 16,800 in Group 1 versus 8,200in Group 2(p = 0.001). Group 1 also had a higher median PPR of 45.7% compared to 23.6% in Group 2(p = 0.011).There was no significant difference in clinical outcomes such as bleeding, infection rates, ICU stay, or mortality between the groups. Multivariate analysis indicated that co-morbidities and higher APACHE-III score were associated with increased mortality.

Conclusion: Transfusion of fresher platelets resulted in higher increments and transfusion effectiveness but did not affect clinical outcomes or mortality. Trial registration details: Clinical Trials Registry of India (CTRI/2023/03/050676).