Solvent detergent treated pooled plasma and reduction of allergic transfusion reactions

摘要

BACKGROUND Thrombotic thrombocytopenic purpura (TTP) patients have increased risk for allergic transfusion reactions (ATR) due to the number of plasma products they require. This study evaluated the efficacy of solvent detergent treated plasma (S/D treated plasma) to reduce ATRs. STUDY DESIGN AND METHODS All TTP patients who presented from April 2014 to February 2015 and experienced a moderate–severe ATR to untreated plasma with TPE were switched to S/D treated plasma (Octaplas) for their remaining procedures and included in the study. Patient records were retrospectively reviewed. RESULTS The overall ATR rate per procedure decreased from 35.0% (95% CI = 15.4%‐59.2%) with untreated plasma to 1.4% ([1/73] 95% CI = 0.0%‐7.4%) with S/D treated plasma. The moderate–severe ATR rate decreased from 20.0% ([4/20] 95% CI = 5.7%‐43.7%) with untreated plasma to 0.0% ([0/73] 95% CI = 0.0%‐4.9%) with S/D treated plasma. The overall ATR rate per plasma unit decreased from 2.6% (95%CI = 1.0%‐5.1%) with untreated plasma to 0.1% (95% CI = 0.0%‐0.4%) with S/D treated plasma. No patients experienced VTE while receiving untreated plasma. Four patients experienced VTE events while receiving S/D treated plasma. All patients who experienced a VTE had additional risk factors for VTE. CONCLUSION S/D plasma has promise as an effective product to reduce the risk of ATRs in TTP patients. Given the high risk of ATR in TTP patients, consideration of S/D plasma instead of untreated plasma for TPE in these patients may be warranted, especially for patients with a history of moderate to severe ATR. More extensive studies are needed to confirm these findings.