Background Febrile, nonhemolytic transfusion reactions are themost frequent adverse reactions to platelets. A number of observationsargue against the widely held view that these reactions resultfrom the interaction between antileukocyte antibodies in therecipient and leukocytes in the platelet product. We soughtto determine whether substances in the plasma or the cells inthe product cause reactions to transfused platelets.
Methods We separated standard platelet concentrates into theirplasma and cellular components and then transfused both portionsin random order. Patients were monitored for reactions duringall transfusions. Before each transfusion, the concentrationof cytokines (interleukin-1 and interleukin-6) was measuredin the platelet products. Studies were also performed on theplatelet products to determine the effect of storage on theconcentration of cytokines.
Results Sixty-four pairs of platelet-product components (theplasma supernatant and the cells) were administered to 12 patients.There were 20 reactions to the plasma supernatant and 6 reactionsto the cells (chi-square = 6.50, P = 0.009). Eight transfusionswere associated with reactions to both products. The plasmacomponent was more likely to cause severe reactions than thecells (chi-square = 9.6, P<0.01). A strong positive correlationwas observed between the reactions and the concentration ofinterleukin-1 and interleukin-6 in the plasma supernatant (P<0.001and P = 0.034, respectively). In vitro studies demonstratedthat interleukin-1 and interleukin-6 concentrations rise progressivelyin stored platelets and that these concentrations are relatedto the leukocyte count in the platelet product.
Conclusions Bioreactive substances in the plasma supernatantof the platelet product cause most febrile reactions associatedwith platelet transfusions. Removing the plasma supernatantbefore transfusion can minimize or prevent these reactions.
Source Information
From the Departments of Pathology and Medicine, McMaster University, and the Transfusion Medicine Service, Chedoke-McMaster Hospitals, Hamilton, Ont. (N.M.H., L.K., C.R., P.F., I.W., J.G.K.); the Department of Health Care and Epidemiology, University of British Columbia, Vancouver (J.S.); and the Canadian Red Cross Blood Transfusion Service, Hamilton Centre, Hamilton, Ont. (J.G.K.).
Address reprint requests to Ms. Heddle at Rm. 2N38, McMaster University Medical Centre, 1200 Main St. W., Hamilton, ON L8N 3Z5, Canada.
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and interleukin-6) was measured in the platelet products. Studies were also performed on the platelet products to determine the effect of storage on the concentration of cytokines. 
