Transfusion reactions after transfusion of platelets stored in PAS-B, PAS-C, or plasma: a nationwide comparison

Transfusion. 2018 Apr;58(4):1021-1027. doi: 10.1111/trf.14509. Epub 2018 Feb 6.


Background: Platelets (PLTs) stored in PLT additive solution (PAS) are associated with fewer allergic reactions than plasma-stored PLTs. However, earlier studies could not provide conclusive evidence on febrile reactions and did not analyze other transfusion reactions separately due to limited sample size. We therefore compared incidences of all transfusion reactions of PAS-B-PLTs, PAS-C-PLTs, and plasma-PLTs.

Study design and methods: In this observational study, all transfusion reactions reported to the national hemovigilance office of the Netherlands from 2006 to 2015 were included.

Results: During the study period, a total of 2407 transfusion reactions after PLT transfusions were reported. In that period 553,267 pooled buffy coat-derived PLT units were issued, of which 83,884 were stored in PAS-B, 45,728 in PAS-C, and 423,655 in plasma. Regarding transfusion-related circulatory overload, transfusion-related acute lung injury, and "other reactions" no significant differences were observed between the PLT products. When PAS-B-PLT transfusions were compared to plasma-PLT transfusions, the overall relative risk (RR; 95% confidence interval [CI]) of transfusion reactions was 0.99 (0.88-1.11); for allergic and febrile nonhemolytic transfusion reactions (FNHTRs) it was 0.66 (0.55-0.80) and 1.54 (1.27-1.86), respectively. When PAS-C-PLTs were compared to plasma-PLTs, the RR (95% CI) was 0.56 (0.46-0.68) for all transfusion reactions, 0.38 (0.28-0.52) for allergic reactions, and 0.82 (0.59-1.13) for FNHTRs. When PAS-C-PLTs were compared to PAS-B-PLTs, for all reactions the RR (95% CI) was 0.56 (0.45-0.70) for allergic reactions 0.58 (0.40-0.82), and for FNHTRs 0.53 (0.37-0.75).

Conclusions: PAS-C-PLTs are associated with fewer transfusion reactions compared to plasma-PLTs and compared to PAS-B-PLTs.

Publication types

  • Comparative Study
  • Multicenter Study
  • Observational Study

MeSH terms

  • Blood Buffy Coat / cytology
  • Blood Platelets / drug effects*
  • Blood Preservation / methods*
  • Blood Safety
  • Humans
  • Hypersensitivity / epidemiology
  • Hypersensitivity / etiology
  • Netherlands / epidemiology
  • Odds Ratio
  • Organ Preservation Solutions / pharmacology*
  • Plasma*
  • Platelet Transfusion / adverse effects*
  • Retrospective Studies
  • Transfusion Reaction / epidemiology
  • Transfusion Reaction / etiology*


  • Organ Preservation Solutions