Platelet-rich-plasmapheresis for minimising peri-operative allogeneic blood transfusion

BACKGROUND: Concerns regarding the safety of transfused blood have generated considerable enthusiasm for the use of technologies intended to reduce the use of allogeneic blood (blood from an unrelated donor). Platelet-rich plasmapheresis (PRP) offers an alternative approach to blood conservation. OBJECTIVES: To examine the evidence for the efficacy of PRP in reducing peri-operative allogeneic red blood cell (RBC) transfusion, and the evidence for any effect on clinical outcomes such as mortality and re-operation rates. SEARCH STRATEGY: Studies were identified by: computer searches of MEDLINE, EMBASE, Current Contents, and the Cochrane Library (to June 2001). These searches were supplemented by checking the reference lists of published articles, reports, and reviews. SELECTION CRITERIA: Controlled parallel group trials in which adult patients, scheduled for non-urgent surgery, were randomised to PRP, or to a control group who did not receive the intervention. DATA COLLECTION AND ANALYSIS: Main outcomes measured were: the number of patients receiving an allogeneic RBC transfusion, and the amount of RBC transfused. Trial quality was assessed using criteria proposed by Schulz et al. (Schulz 1995) and Jadad et al. (Jadad 1996). MAIN RESULTS: Nineteen trials of PRP were identified that reported data for the number of patients exposed to allogeneic RBC transfusion. These trials evaluated a total of 1452 patients. The pooled relative risk (RR) of exposure to allogeneic blood transfusion in those patients randomised to PRP was 0.71 (95%CI: 0.56, 0.90), equating to a relative risk reduction (RRR) of 29%; the average absolute risk reduction (ARR) was 19% (RD = -0.19: 95%CI: -0.29, -0.09). On average, PRP did not significantly reduce the total volume of RBC transfused (weighted mean difference [WMD] = -0.69: 95%CI: -1.93, 0.56 units). Substantial statistical heterogeneity was observed (p < 0.001). Trials provided inadequate data regarding the impact of PRP on morbidity, mortality, and hospital length of stay. The majority of trials were small and of poor methodological quality. REVIEWER'S CONCLUSIONS: Although the results suggest that PRP is effective in reducing allogeneic RBC transfusion in adult patients undergoing elective surgery, there was considerable heterogeneity in treatment effects and the trials were of poor methodological quality. As the majority of trials were unblinded, transfusion practices may have been influenced by knowledge of the patient's allocation status, potentially exaggerating the true magnitude of the beneficial effect of PRP. The available studies provided inadequate data for firm conclusions to be drawn regarding the impact of PRP on clinically important endpoints.