Apheresis and whole blood derived platelets: Which product is best?

There are two approaches to the preparation of platelets: apheresis collections and the separation of platelets from whole blood by using either the buffy coat technique or centrifugation from platelet rich plasma [1]. The debate over which method results in the best platelet product has continued for many years and there is still no consensus on this issue. The answer will also be dependent on the definition of ‘best’ and whether the perspective is that of the supplier or the hospital transfusion service. Those who favour apheresis platelet products indicate that they are superior for many reasons including: reduction in the number of donor exposures for transfused recipients; improved bacterial safety profile; on-line/in-processing leukocyte reduction; and operational efficiencies and cost savings as multiple transfusion doses can be obtained from a single donation, and less laboratory time is needed in the hospital for preparation. Similarly, those who advocate platelets derived from whole blood describe some of the benefits as: lesser cost; optimal utilization of the entire ‘volunteer’ whole blood donation; and the ease of adaptability for pediatric and neonatal platelet dosing. However, even those who favour whole blood derived platelets can not necessarily agree on whether one preparation method is superior to the other. Table 1 summarizes some of the benefits proposed for the three types of platelet products. In this chapter, the current methods for platelet production will be reviewed and considerations for selection of the manufacturing method and product will be presented under the headings of bacterial screening, laboratory and clinical evidence to support the concepts of product equivalency or superiority, cost, and other considerations such as the need for CMV negative products and HLA matching.