Routine Use of Platelet Components Prepared with Photochemical Treatment (INTERCEPT Platelets™): Impact on Clinical Outcomes and Resources.
Authors: Osselaer Jean Claude , Doyen Chantal , Messe Natalie , Van Hooydonk Maryse , Jacquet Michele , Sonnet Anne , Bosly Andre , Flament Jocelyne , Corash Laurence 
Published: April 2020

Abstract
Background: In 2003 the Blood Transfusion Center (BTC), Cliniques Universitaires Mont Godinne (CUMG) initiated routine use of INTERCEPT Platelets (I-P) for support of thrombocytopenia. To examine the impact of I-P on patient (Pt) outcomes and resources, the rate of acute transfusion reactions (ATR) for platelet (PLT) and red cell (RBC) transfusions (txn) and the effect on platelet use were compared for 18 months before I-P adoption, when only conventional platelets (C-P) were used, and for 18 months after adoption of I-P. Since preparation of RBC did not change, the rates of PLT-ATR and RBC-ATR in the 2 periods were used to assess the impact of I-P on ATR.
Methods: In both periods, PLT were collected on the Amicus Separator™ (Baxter) with process leukocyte reduction. For C-P, T-Sol™ (Baxter) with a ratio to plasma of 70:30 % was used; and for I-P, Intersol™ (Baxter)with a ratio to plasma of 65:35 % was used. I-P containing 2.5 to 6.0 x 1011 plts in 300 mL were treated with amotosalen (150 μM) plus UVA (3 J/cm2) to inactivate pathogens and leukocytes. As for C-P, I-P units were issued the day (d) after collection and stored for either 5 or 7 d. Clinical services reported febrile and non-febrile ATR occurring within 24 hr of txn to the BTC. HLA and PLT antibodies (AB+/AB−) were determined by the BTC in pts with suspected alloimmunization.
Results-Table: The number of patients transfused with PLT and RBC increased by 13% and 8%, respectively, after I-P adoption; and the mean plt dose increased by 3.6% (4.14 vs 4.29 x 1011). The relative distribution of components by primary care indications was similar in the 2 periods. After adoption of I-P, the incidence of ATR decreased significantly (p=0.002), largely due to fewer ATR in pts without AB detected (AB-). I-P adoption did not substantially increase component utilization, did not require addition of personnel to the BTC, nor delay time of PLT issue. I-P did not affect the number of plt donors required to support the CUMG patient population. I-P replaced gamma irradiation for prevention of txn-associated GVHD, avoided use of routine bacterial testing, and replaced CMV serology. Adoption of I-P facilitated extension of PLT storage from 5 to 7 d, with a decreased rate of component expiration from 7.2% to 3.7%.
Conclusions: Use of I-P resulted in a decreased incidence of ATR to PLT txn. The average dose of I-P was minimally higher than C-P, and the number of PLT txn/pt was slightly increased. Adoption of I-P did not adversely impact donor recruitment, utilization of resources, or BTC personnel resources to prepare components. I-P replaced other technologies, thus reducing the net cost impact of adoption.
Impact of I-P Adoption On Component Use and ATR Component C-P C-RBC I-P C-RBC Period Before Before After After Units Transfused 3,529 9,551 4,051 11,493 Hematology 3,070 (87%) 4,202 (44%) 3,524 (87%) 4,942 (43%) Oncology 141 (4%) 382 (4%) 81 (2%) 575 (5%) CV Surgery 140 (4%) 2,388 (25%) 203 (5%) 2,528 (22%) Other 178 (5%) 2,579 (27%) 243 (6%) 3,448 (30%) Patients 353 1581 402 1719 Units/Pt 10.0 6.0 10.1 6.7 Febrile ATR 1.3% 0.4% 0.9% 0.4% AB+/AB− 18/21 19/14 Urticaria 6 4 5 3 Sepsis 1 1 0 0