In the U.S., more than 90% of the platelets used for transfusion are collected by apheresis.¹ Today, though, the country’s platelet supply is at risk due to an aging donor population and a declining number of apheresis platelet donations.^1,2

Globally, many countries have balanced their platelet needs with a combination of apheresis platelets and whole blood-derived platelets (WBDPs). It’s a strategy that could also help the U.S. maintain a stable supply. In many cases, WBDPs and apheresis platelets are clinically equivalent.^3,4 Before deciding whether to use WBDPs at your blood center or for a particular patient, it’s important to take certain clinical considerations into account. Here, we review four of those important factors.

Apheresis platelets versus WBDPs

First, a quick reminder of the basic difference between these two types of platelet collection.

• Apheresis platelets are collected from a single donor using an apheresis device that leukoreduces the platelet product while simultaneously returning red blood cells and plasma to the donor.
• WBDPs are created by pooling intermediate platelet units from up to six different whole blood donors into a transfusable dose. These platelets can also be leukoreduced through filtration during pooling, before storage.

Clinical considerations

These four points address factors that should be considered when deciding whether to use WBDPs.

• Donor exposure. In the 1980s, apheresis platelets were considered safer than pooled WBDPs since platelets from a single person were thought to limit donor exposure to transfusion-transmitted infections (TTIs).^3,4  However, advances in donor testing and recent improvements in donor screening have greatly reduced the risk of TTIs.⁵ In addition, epidemiological surveillance has shown that the risk of TTIs associated with WBDPs is comparable to the risk associated with apheresis platelets.⁶
• Alloimmunization. The Trial to Reduce Alloimmunization to Platelets (TRAP) study showed that apheresis platelets provided no additional benefit over WBDPs in preventing alloimmunization.⁷
• Clinical efficacy. While apheresis platelets are associated with higher post-transfusion corrected count increments (CCIs), studies have shown that this does not impact the prevention of bleeding (WHO grade 2 or higher).^3,8
• Crossmatching. Apheresis platelets allow for human leukocyte antigen (HLA) and human platelet antigen (HPA) matching, which can be important for improving outcomes in patients with platelet refractoriness.⁹  

The bottom line

Apheresis platelets will always play a role for certain patient populations. However, current information shows that WBDPs can be a viable alternative. Diversifying the platelet supply with both apheresis platelets and WBDPs can help ease the burden on blood centers and help meet demand — and support ongoing patient care.

To learn about solutions that can assist blood centers with safe, efficient methods for collecting WBDPs, contact your Terumo Blood and Cell Technologies representative.
 

1. Free RJ, et al. Continued stabilization of blood collections and transfusions in the United States: Findings from the 2021 National Blood Collection and Utilization Survey. Transfusion. 2023;63(suppl 4):S8-S18.
2. Lasky B, et al. Young apheresis platelet donors show significant and sustained growth over the last decade in the US, 2010-2019: A favorable sign of the resiliency of the platelet supply. Transfusion. 2023;63(7):1333-1343.
3. Seheult JN, et al. I am the 9%: Making the case for whole blood platelets. Transfus Med. 2016;26(3):177-185.
4. Yazer MH, Razatos A, Sayers M. Whole blood derived and apheresis platelets: Opinions and preferences — the results of a national survey of blood collectors. Transfusion. 2023;63(6):1224-1229.
5. Thiele T, et al. Implications of a switch to 100% apheresis platelet supply for patients and for blood donors: a risk benefit analysis. Vox Sang. 2016;111(4):350-356.
6. an der Heiden M, et al. Estimating the residual risk for HIV, HCV, and HBV in different types of platelet concentrates in Germany. Vox Sang. 2015;108(2):123-130.
7. TRAP Study Group. Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions. N Engl J Med. 1997;337(26):1861-1870.
8. Triulzi DJ, et al. The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia. Blood. 2012;119(23):5553-5562.
9. Kekomäki R. Use of HLA- and HPA-matched platelets in alloimmunized patients. Vox Sang. 1998;74(suppl 2):359-363.