Millions of platelet transfusions are done every year, and febrile (fever) reactions occur in around a third of cases. Most reactions are mild, but occasionally life-threatening lung failure can occur.
Richard Phipps and colleagues from the University of Rochester, USA, proposed that febrile responses in patients receiving platelets could be due to the release of CD40 ligand, a protein in the platelets that interacts with a receptor and is thought to be associated with the production of proinflammatory prostaglandin E2 (PGE2), the key inducer of fever in man. The investigators randomly assessed 9 preparations of platelets due for transfusion; the amounts of CD40 ligand (3000 ng/L to more than 7000 ng/L) were similar to concentrations found in human blood during chronic inflammation.
Richard Phipps comments: "If platelet soluble CD40 ligand is confirmed as the cause of these febrile responses, then we speculate that keeping the release of CD40 ligand to a minimum, or removing free CD40 ligand before transfusion, might effectively reduce adverse events after platelet transfusions. Moreover, individuals whose platelets are especially rich in CD40 ligand might prove less suitable as donors for transfusions."
Contact: Dr. Richard Phipps, Department of Microbiology and Immunology, University of Rochester Cancer Center, Rochester, NY 14642, USA; t) +1 716-275-7836; F) +1 716 273 1042; E) Richard_Phipps@urmc.rochester.edu
Journal
The Lancet