Platelet transfusion

Platelet transfusions may be given to prevent bleeding when the platelet count falls below a certain threshold, prior to a procedure, or to treat bleeding associated with thrombocytopenia (a low platelet count). It may also be given to people with inherited or acquired platelet function abnormalities (e.g. Glanzmann's thrombasthenia, or treatment with antiplatelet drugs). Unlike other blood products demand for platelet transfusions appears to be increasing in several countries around the world, including Australia, the UK, and the USA.[1]

People with haematological and oncological disorders are the patient group who receive the largest proportion of platelet transfusions because platelet transfusions are an important supportive therapy during treatment with chemotherapy or a stem cell transplant.[2][3][4] Much of the remainder are used in general medicine, cardiac surgery and in intensive care.[2][3][4]

An ageing population, an increase in the incidence of haematological malignancies, and changes to the management of haematological malignancies are likely to be the major reasons for the rise in demand for platelet components.[1] Since 1990, the number of stem cell transplants performed in Europe has risen from 4,200 to over 30,000 annually.[5]

Prophylactic platelet transfusions

International guidelines recommend that platelets transfusions are given to people with reversible bone marrow failure to reduce the risk of spontaneous bleeding when the platelet count is less than 10 x 109/L.[6][7][8]

Prophylactic platelet transfusions versus therapeutic platelet transfusions

A recent Cochrane systematic review in people with haematological malignancies found that overall giving platelet transfusions when the platelet count is less than 10 x 109/L reduced the number of bleeding events and days with significant bleeding.[9] However, this benefit was only seen in certain patient groups, and people undergoing an autologous stem cell transplant derived no obvious benefit.[9]

Prophylactic platelet transfusion dose

A recent Cochrane systematic review in people with haematological malignancies compared different platelet transfusion doses.[10] This review found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets (low dose - 1.1 x 1011/m2) and those that contained an intermediate number of platelets (intermediate dose - 2.2 x 1011/m2). This review also found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets and those that contained a large number of platelets (high dose - 4.4 x 1011/m2).[10] One of the review's included studies reported on transfusion reactions. This study’s authors suggested that a high-dose platelet transfusion strategy may lead to a higher rate of transfusion-related adverse events.[11]

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References

  1. 1 2 Estcourt, L. J. (2014-10-01). "Why has demand for platelet components increased? A review". Transfusion Medicine (Oxford, England). 24 (5): 260–268. doi:10.1111/tme.12155. ISSN 1365-3148. PMID 25327286.
  2. 1 2 Cameron, Bruce; Rock, Gail; Olberg, Bernard; Neurath, Doris (2007-02-01). "Evaluation of platelet transfusion triggers in a tertiary-care hospital". Transfusion. 47 (2): 206–211. doi:10.1111/j.1537-2995.2007.01090.x. ISSN 0041-1132. PMID 17302765.
  3. 1 2 Charlton, A.; Wallis, J.; Robertson, J.; Watson, D.; Iqbal, A.; Tinegate, H. (2014-08-01). "Where did platelets go in 2012? A survey of platelet transfusion practice in the North of England". Transfusion Medicine (Oxford, England). 24 (4): 213–218. doi:10.1111/tme.12126. ISSN 1365-3148. PMID 24957661.
  4. 1 2 Whitaker, Barbee I; Rajbhandary, Srijana; Harris, Angela (2015). The 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey Report. AABB.
  5. ↑ Passweg, J. R.; Baldomero, H.; Gratwohl, A.; Bregni, M.; Cesaro, S.; Dreger, P.; de Witte, T.; Farge-Bancel, D.; Gaspar, B. (2012-07-01). "The EBMT activity survey: 1990-2010". Bone Marrow Transplantation. 47 (7): 906–923. doi:10.1038/bmt.2012.66. ISSN 1476-5365. PMID 22543746.
  6. ↑ Kaufman, Richard M.; Djulbegovic, Benjamin; Gernsheimer, Terry; Kleinman, Steven; Tinmouth, Alan T.; Capocelli, Kelley E.; Cipolle, Mark D.; Cohn, Claudia S.; Fung, Mark K. (2015-02-03). "Platelet Transfusion: A Clinical Practice Guideline From the AABB". Annals of Internal Medicine. 162 (3): 205–213. doi:10.7326/M14-1589. ISSN 0003-4819.
  7. ↑ "Blood transfusion | Guidance and guidelines | NICE". www.nice.org.uk. Retrieved 2016-01-21.
  8. ↑ "Patient Blood Management Guidelines | National Blood Authority". www.blood.gov.au. Retrieved 2016-01-21.
  9. 1 2 Crighton, Gemma L.; Estcourt, Lise J.; Wood, Erica M.; Trivella, Marialena; Doree, Carolyn; Stanworth, Simon (2015-01-01). "A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 9: CD010981. doi:10.1002/14651858.CD010981.pub2. ISSN 1469-493X. PMC 4610062Freely accessible. PMID 26422767.
  10. 1 2 Estcourt, Lise J.; Stanworth, Simon; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Blanco, Patricia; Murphy, Michael F. (2015-01-01). "Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 10: CD010984. doi:10.1002/14651858.CD010984.pub2. ISSN 1469-493X. PMC 4724938Freely accessible. PMID 26505729.
  11. ↑ Kaufman, Richard M.; Assmann, Susan F.; Triulzi, Darrell J.; Strauss, Ronald G.; Ness, Paul; Granger, Suzanne; Slichter, Sherrill J. (2015-01-01). "Transfusion-related adverse events in the Platelet Dose study". Transfusion. 55 (1): 144–153. doi:10.1111/trf.12791. ISSN 1537-2995. PMC 4293226Freely accessible. PMID 25065959.
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