Platelet Transfusion - Threshold

2/23/2005

Question:  What is the proper threshold or trigger value for platelet transfusion?

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15987349.ui or 14710693.ui or 12757525.ui or 12757517.ui or 12434952.ui or 12007974.ui or 11606818.ui or 11342358.ui or 9950093.ui or 9864920.ui or 9864912.ui or 9709789.ui or 9407153.ui or 9060557.ui or 8136604.ui

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15987349[PMID] OR 14710693[PMID] OR 12757525[PMID] OR 12757517[PMID] OR 12434952[PMID] OR 12007974[PMID] OR 11606818[PMID] OR 11342358[PMID] OR 9950093[PMID] OR 9864920[PMID] OR 9864912[PMID] OR 9709789[PMID] OR 9407153[PMID] OR 9060557[PMID] OR 8136604[PMID]

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<1>

Unique Identifier [PMID]: 15987349

Authors: Diedrich B. Remberger M. Shanwell A. Svahn BM. Ringden O.

Institution: Department of Transfusion Medicine, Karolinska University Hospital at Huddinge, Stockholm, Sweden. beatrice.diedrich@karolinska.se

Title: A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 10(9) per L versus 30 x 10(9) per L in allogeneic hematopoietic progenitor cell transplant recipients.

Source: Transfusion. 45(7):1064-72, 2005 Jul.

Abstract: BACKGROUND: The impact of lowering the platelet (PLT) count threshold for prophylactic PLT transfusion on bleeding and PLT use in allogeneic hematopoietic progenitor cell (HPC) transplant recipients is a matter of debate. STUDY DESIGN AND METHODS: In 166 patients, randomly assigned to receive prophylactic PLT transfusion at a trigger level less than 10 x 10(9) PLTs per L (T10; n = 79) or less than 30 x 10(9) per L (T30; n = 87), the number of PLT and red blood cell (RBC) transfusions given and the number of hemorrhagic events (WHO Grades 2-4) were recorded. RESULTS: No significant differences were found between the two groups regarding the clinical outcome variables (i.e., bacteremia, engraftment, graft-vs.-host disease [GVHD], hospital stay, death, and survival) or in the median total number of RBC transfusions given. The incidence, in Group T10 18 percent (14/79) and in Group T30 15 percent (13/87), as well as the type of bleeding were comparable. No deaths were attributed to hemorrhages. The number of PLT units transfused, however, was significantly lower in Group T10 (median, 4; range, 0-32), than in Group T30 (median, 10; range, 0-48; p < 0.001). Apart from the trigger level, the day of engraftment, the presence of acute GVHD, or bacteremia also affected the number of PLT transfusions. CONCLUSION: A prophylactic PLT transfusion trigger level of less than 10 x 10(9) PLTs per L instead of less than 30 x 10(9) PLTs per L in allogeneic HPC transplant recipients was found to be safe and resulted in a decreased use of PLTs.

Publication Type: Clinical Trial. Journal Article. Randomized Controlled Trial.

<2>

Unique Identifier [PMID]: 14710693

Authors: Drews RE.

Institution: Department of Medicine, Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. rdrews@bidmc.harvard.edu

Title: Critical issues in hematology: anemia, thrombocytopenia, coagulopathy, and blood product transfusions in critically ill patients. [Review] [62 refs]

Source: Clinics in Chest Medicine. 24(4):607-22, 2003 Dec.

Abstract: Systematic evaluations of anemia, thrombocytopenia, and coagulopathy are essential to identifying and managing their causes successfully. In all cases, clinicians should evaluate RBC measurements alongside WBC and platelet counts and WBC differentials. Multiple competing factors may coexist; certain factors affect RBCs independent of those that affect WBCs or platelets. Ideally, clinicians should examine the peripheral blood smear for morphologic features of RBCs, WBCs, and platelets that provide important clues to the cause of the patient's hematologic disorder. Thrombocytopenia arises from decreased platelet production, increased platelet destruction, or dilutional or distributional causes. Drug-induced thrombocytopenias present diagnostic challenges, because many medicines can cause thrombocytopenia and critically ill patients often receive multiple medications. If they suspect type II HIT, clinicians must promptly discontinue all heparin sources, including LMWHs, without awaiting laboratory confirmation, to avoid thrombotic sequelae. Because warfarin anticoagulation induces acquired protein C deficiency, thereby exacerbating the prothrombotic state of type II HIT, warfarin should be withheld until platelet counts increase to more than 100,000/microL and type II HIT is clearly resolving. The presence of a consumptive coagulopathy in the setting of thrombocytopenia supports a diagnosis of DIC, not TTP-HUS, and is demonstrated by decreasing serum fibrinogen levels, and increasing TTs, PTs, aPTTs, and fibrin degradation products. Increasing D-dimer, levels are the most specific DIC parameter and reflect fibrinolysis of cross-linked fibrin. Elevated PTs or a PTTs can result from the absence of factors or the presence of inhibitors. Clinicians should suspect factor inhibitors when the prolonged PT or aPTT does not correct or only partially corrects following an immediate assay of a 1:1 mix of patient and normal plasma. In addition to factor inhibitors, antiphospholipid antibodies (e.g., lupus anticoagulant) can produce a prolonged aPTT that does not correct with normal plasma but is overcome by adding excess phospholipid or platelets. Paradoxically, a tendency to thrombosis, not bleeding, accompanies lupus anticoagulants and the antiphospholipid antibody syndrome. Transfusion of red blood cells, platelets, or plasma products is sometimes warranted, but clinicians must carefully weigh potential benefits against known risks. In critically ill patients, administering RBCs can enhance oxygen delivery to tissues. Among euvolemic patients who do not have ischemic heart disease, guidelines recommend a transfusion threshold of HGB levels in the range of 6.0 to 8.0 g/dL; patients who have HGB that is at least 10.0 g/dL are unlikely to benefit from blood transfusion. The use of rHuEPO to increase erythropoiesis offers an alternative to RBC transfusion, assuming normal, responsive progenitor cells and adequate iron, folate, and cobalamin stores. Future research should examine whether clinical outcomes from rHuEPO use in critically ill patients are important and cost-effective. Because platelets play an instrumental role in primary hemostasis, platelet transfusions are often important in managing patients who are bleeding or at risk of bleeding with thrombocytopenia or impaired platelet function. Platelet transfusions carry risks, and decisions to transfuse platelets must consider clinical circumstances. Most important, platelet transfusions are generally contraindicated if the underlying disorder is TTP or type II HIT, because platelet transfusion in these settings may fuel thrombosis and worsen clinical signs and symptoms. Plasma products can correct hemostasis when bleeding arises from malfunction, consumption, or underproduction of plasma coagulation proteins. Choice of plasma product for transfusion depends on clinical circumstances. FFP is the most commonly used plasma product to correct clotting factor deficiencies, particularly coagulopathies that are attributable to multiple clotting factor deficiency states as in liver disease, DIC, or warfarin anticoagulation. PCC or rFVIIa that is administered in small volumes may provide advantages over FFP when coagulopathies require quick reversal without risk of volume overload. Factor concentrates can replace specific factor deficiencies. Recombinant FVIIa bypasses inhibitors to factors VIII and IX and vWF. Use of rFVIIa in managing hemostatic abnormalities from severe liver dysfunction; extensive surgery, trauma, or bleeding; excessive warfarin anticoagulation; and certain platelet disorders requires further study to determine optimal and cost-effective dosing regimens. Recombinant activated protein C reduces mortality from severe sepsis that is associated with organ dysfunction in adults who are at high risk for death (APACHE scores of at least 25). In severe sepsis, levels of protein C decrease, as do fibrinogen and platelet levels. Because of its anticoagulant effect, however, drotrecogin alfa may induce bleeding. Guidelines for drotrecogin alfa use must take into account bleeding risks. [References: 62]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 12757525

Authors: Heddle NM. Cook RJ. Webert KE. Sigouin C. Rebulla P. Biomedical Excellence for Safer Transfusion Working Party of the International Society for Blood Transfusion.

Institution: Department of Medicine, McMaster University, Hamilton, Ontario, Canada. heddlen@mcmaster.ca

Title: Methodologic issues in the use of bleeding as an outcome in transfusion medicine studies.[see comment].

Comments Comment in: Transfusion. 2003 Dec;43(12):1761-3; author reply 1763; PMID: 14674376, Comment in: Transfusion. 2003 Jun;43(6):691-3; PMID: 12757517

Source: Transfusion. 43(6):742-52, 2003 Jun.

Abstract: BACKGROUND: Prophylactic platelet transfusions are given to thrombocytopenic patients to prevent bleeding. The benefit of platelet transfusions has frequently been assessed by measuring the count increment; however, more recently, an assessment of bleeding has been used because it is a more clinically relevant outcome measure. The purpose of this study was to identify platelet transfusion trigger studies that used bleeding as an outcome measure, compare and contrast methods used to document bleeding and analyze bleeding outcomes, and identify and discuss methodologic issues to consider when bleeding is used as a study outcome. STUDY DESIGN AND METHODS: A systematic search to identify platelet transfusion trigger studies was performed. Relevant articles were reviewed to identify how bleeding data was captured and analyzed, and methodologic considerations were identified. RESULTS: Seven articles meeting the predefined entry criteria were identified. Methods used to document bleeding included chart review and clinical assessment. The frequency of assessment and the type of personnel performing the assessment were variable. Four approaches to analysis were identified: descriptive; comparison of the proportions of patients having at least one bleed; comparison of patient days with bleeding expressed as a proportion of the total days at risk of bleeding; and time-to-event (first bleed) analysis. CONCLUSION: Methodologic issues for consideration when designing a clinical study with bleeding as the outcome measure included approaches to minimize bias in the documentation and classification of bleeding and selection of an analysis approach that is appropriate to the question being asked. The need for development of a valid and reliable bleeding scale was also identified.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 12757517

Authors: Corash L.

Title: How much do we know about the platelet transfusion threshold?[comment].

Comments Comment on: Transfusion. 2003 Jun;43(6):742-52; PMID: 12757525

Source: Transfusion. 43(6):691-3, 2003 Jun.

Publication Type: Comment. Editorial.

<5>

Unique Identifier [PMID]: 12434952

Authors: Zumberg MS. del Rosario ML. Nejame CF. Pollock BH. Garzarella L. Kao KJ. Lottenberg R. Wingard JR.

Institution: University of Florida College of Medicine, Department of Medicine, Gainesville 32610, USA. zumbems@medicine.ufl.edu

Title: A prospective randomized trial of prophylactic platelet transfusion and bleeding incidence in hematopoietic stem cell transplant recipients: 10,000/L versus 20,000/microL trigger.

Source: Biology of Blood & Marrow Transplantation. 8(10):569-76, 2002.

Abstract: An optimal platelet-count threshold for prophylactic platelet transfusion in hematopoietic stem cell transplant (HSCT) recipients has yet to be determined. Between July 1997 and December 1999, we performed the first prospective randomized clinical trial addressing this issue in 159 HSCT recipients who received a prophylactic platelet transfusion when the morning platelet count fell below a 10,000/microL (10K) or 20,000/microL (20K) threshold. Subsequent prophylactic transfusions were administered according to a predetermined algorithm. The number of prophylactic and therapeutic transfusions and the incidence of minor and major bleeding were compared between the 2 groups. The groups were matched according to patient and transplantation characteristics. There were no significant differences in bleeding incidence or severity. Fourteen percent of patients in the 10K arm compared to 17% in the 20K arm had major bleeding events. Only 3 central nervous system bleeds occurred, 2 in the 10K group and 1 in the 20K group. No deaths were attributed to bleeding. An average of 11.4 days of bleeding occurred in both groups. An average of 10.4 platelet transfusions per patient were administered in the 10K group compared to 10.2 in the 20K group (P = .94). More transfusions were given above the assigned transfusion threshold in the 10K group than in the 20K group (4.3/patient versus 1.9/patient, respectively, P = .05). Safety measures incorporated into our study may have precluded demonstration of significant differences in platelet use between the groups. In conclusion, a platelet transfusion trigger of 10K was found to be safe; however, a decrease in platelet use was not achieved because of safety measures incorporated into our study design.

Publication Type: Clinical Trial. Journal Article. Randomized Controlled Trial.

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Unique Identifier [PMID]: 12007974

Authors: Benjamin RJ. Anderson KC.

Institution: Dana Farber/Partners Cancer Care, Harvard Medical School, Boston, MA, USA. rbenjamin@partners.org

Title: What is the proper threshold for platelet transfusion in patients with chemotherapy-induced thrombocytopenia?. [Review] [49 refs]

Source: Critical Reviews in Oncology-Hematology. 42(2):163-71, 2002 May.

Abstract: Platelet transfusion therapy is an integral part of modern oncological practice and is used to treat hemorrhage associated with thrombocytopenia. More commonly, platelets are transfused to prevent hemorrhage in thrombocytopenic patients. Conventional wisdom has suggested a threshold for prophylactic transfusion of <20x10(9)/l. Many studies now support the safety of more conservative transfusion regimes that reduce patient exposure to donors and conserve precious resources, without an increase in risk of hemorrhage. This review presents the data to support the use of a prophylactic transfusion threshold of <10x10(9)/l in patients without risk factors for hemorrhage and who have ready access to emergent medical care. [References: 49]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 11606818

Authors: Arroyo JL. Garcia-Marcos MA. Lopez A. Menendez P. Tabernero MD. Sanchez-Abarca LI. Avila-Zarza C. San Miguel JF. Orfao A.

Institution: Hematology Service, University of Salamanca and University Hospital of Salamanca , Spain.

Title: Evaluation of a CD61 MoAb method for enumeration of platelets in thrombocytopenic patients and its impact on the transfusion decision-making process.

Source: Transfusion. 41(10):1212-6, 2001 Oct.

Abstract: BACKGROUND: Almost all automated hematology cell analyzers use methods based on either the impedance (PLTi) or the optical (PLTo) properties of the cells for performing platelet counts. To improve the accuracy of platelet counts in peripheral blood (PB), the use of CD61 (GPIIIa) MoAbs (ImmunoPLT method) has recently been introduced in an automated hematology blood-analyzer system (Cell-Dyn 4000, Abbott Diagnostics). STUDY DESIGN AND METHODS: A comparative evaluation was made of the accuracy and precision of the three methods currently available in the Cell-Dyn 4000 automated hematology cell analyzer for counting the number of platelets per microliter of PB in a total of 47 patients with chemotherapy-induced thrombocytopenia. A flow cytometric PB platelet count was also performed in parallel and used as an external reference. RESULTS: PB platelet counts showed a good correlation among the PLTo, CD61-ImmunoPLT, and flow cytometric methods. In contrast, the PLTi procedure usually provided an overestimation of the number of platelets per microliter. Although a good correlation was observed between the flow cytometric reference method and both the ImmunoPLT and PLTo methods, the highest degree of agreement was found for the ImmunoPLT techniques (94% vs. 67%). A comparative analysis of the PLTo and CD61-ImmunoPLT methods with regard to their value for predicting platelet transfusion needs on the basis of specific flow cytometric platelet count thresholds showed a good correlation when the cutoff level of 10,000 platelets per microL was used. In contrast, at the threshold of 20,000 platelets per microL, slight differences were observed between the PLTo and CD61-ImmunoPLT procedures for predicting transfusion needs. CONCLUSION: Such results indicate that, if the CD61-ImmunoPLT method is used in the platelet transfusion decision-making process, unnecessary platelet transfusions could be avoided in up to 17.5 percent of persons with a PLTo count of <20,000 platelets per microL.

Publication Type: Evaluation Studies. Journal Article.

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Unique Identifier [PMID]: 11342358

Authors: Lawrence JB. Yomtovian RA. Hammons T. Masarik SR. Chongkolwatana V. Creger RJ. Manka A. Lazarus HM.

Institution: Institute of Pathology; Reserve University and University Hospitals of Cleveland, OH 44106, USA.

Title: Lowering the prophylactic platelet transfusion threshold: a prospective analysis.

Source: Leukemia & Lymphoma. 41(1-2):67-76, 2001 Mar.

Abstract: The 20 x 10(9) /L threshold for prophylactic platelet transfusion may be unnecessarily high. Few prospective studies, however, in which other trigger values were tested have been published. In this study all hospitalized, thrombocytopenic adult hematology-oncology patients in our institution were prospectively evaluated daily for hemorrhage and platelet transfusion during a one year period; no patients were excluded for bleeding or infectious problems. By design, during the initial six-months (baseline period), the prophylactic platelet transfusion trigger was 20 x 10(9) /L; for the second six-months (study period) this threshold was changed to 10 x 10(9) /L. Patients studied during the two periods did not differ significantly in age, gender, diagnosis, blood or marrow transplant status, and duration of neutropenia. Compliance with the thresholds was 95.6% (baseline period) and 93.5% (study period). For patients with platelet counts under 20 x 10(9) /L, the mean use of platelet transfusions per patient per day was significantly lower in the study period (4.47) than in the baseline period (6.48; p<0.001). Both mean prophylactic (1.54/patient-day) and therapeutic (2.93/patient-day) platelet transfusions were reduced in the study period compared with the baseline period (2.26 and 4.22/patient-day, respectively). Hemorrhage was slightly reduced in the study period compared with the baseline period: major hemorrhage, 15.2% vs. 18.4% (p=0.014); minor hemorrhage, 63.6% vs. 70.1% (p<0.001). Thus, hemorrhage was not increased with the lower trigger level. A 10 x 10(9) /L prophylactic platelet transfusion threshold value is safe and effective.

Publication Type: Clinical Trial. Journal Article.

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Unique Identifier [PMID]: 9950093

Authors: Ancliff PJ. Machin SJ.

Institution: Department of Haematology, University College Hospital, London, UK.

Title: Trigger factors for prophylactic platelet transfusion. [Review] [23 refs]

Source: Blood Reviews. 12(4):234-8, 1998 Dec.

Abstract: The level of 20x10(9)/L for prophylactic platelet transfusion has rightly been challenged over the last few years, with some units recommending a level as low as 5x10(9)/L. The higher levels are usually based on retrospective data from the 1950s. We examined the more recent data and came to the conclusion that a threshold of 10x10(9)/L is safe in the stable patient; higher levels are recommended for specific clinical circumstances. This threshold will reduce donor exposure, costs and possibly donor alloimmunization. The dearth of prospective controlled clinical trials in the literature also presents an opportunity for both in-house and national audit. [References: 23]

Publication Type: Historical Article. Journal Article. Review.

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Unique Identifier [PMID]: 9864920

Authors: Navarro JT. Hernandez JA. Ribera JM. Sancho JM. Oriol A. Pujol M. Milla F. Feliu E.

Institution: Hematology-Hemotherapy Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.

Title: Prophylactic platelet transfusion threshold during therapy for adult acute myeloid leukemia: 10,000/microL versus 20,000/microL.[see comment].

Comments Comment in: Haematologica. 1998 Nov;83(11):961-2; PMID: 9864912

Source: Haematologica. 83(11):998-1000, 1998 Nov.

Abstract: BACKGROUND AND OBJECTIVE: The threshold for prophylactic platelet transfusions has been classically established at 20,000/microL. In 48 patients with de novo acute myeloblastic leukemia (AML) we analyzed the effect of reducing the threshold for prophylactic platelet transfusion from 20,000/microL (group A) to 10,000/microL (group B) after induction and consolidation chemotherapy. DESIGN AND METHODS: Forty-eight adult patients with de novo AML diagnosed in a single institution in a nine year period were enrolled in the study. Between January 1989 and December 1993 the patients received prophylactic platelet transfusions when their platelet count was below 20,000/microL (group A), and from January 1994 to March 1998 prophylactic platelet transfusions were indicated below 10,000/microL or between 10,000/microL and 20,000/microL if there was any consumption factor. RESULTS: The mean number (SD) of platelet transfusions during induction was 8.4 (5.3) in group A and 8.5 (5.5) in group B; and during consolidation 4.7 (3.4) in group A and 4.6 (3.8) in group B (p = n.s.). Excluding the cases with consumption factors from the analysis, group B patients required 34% fewer transfusions during induction and 15.5% fewer during consolidation (p = 0.04). There were no differences between groups regarding major bleeding episodes. INTERPRETATION AND CONCLUSIONS: Our data show that the threshold for prophylactic platelet transfusion can be safely set at 10,000 microL during induction and consolidation chemotherapy for adult patients with de novo AML.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 9864912

Authors: Finazzi G.

Title: Prophylactic platelet transfusion in acute leukemia: which threshold should be used.[comment].

Comments Comment on: Haematologica. 1998 Nov;83(11):998-1000; PMID: 9864920

Source: Haematologica. 83(11):961-2, 1998 Nov.

Publication Type: Comment. Editorial.

<12>

Unique Identifier [PMID]: 9709789

Authors: Contreras M.

Institution: Blood Transfusion Service, North London Blood Transfusion Centre, United Kingdom.

Title: Final statement from the consensus conference on platelet transfusion.[see comment]. [Review] [0 refs]

Comments Comment in: Transfusion. 1998 Aug;38(8):707-9; PMID: 9709776

Source: Transfusion. 38(8):796-7, 1998 Aug.

Publication Type: Consensus Development Conference. Journal Article. Review.

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Unique Identifier [PMID]: 9407153

Authors: Rebulla P. Finazzi G. Marangoni F. Avvisati G. Gugliotta L. Tognoni G. Barbui T. Mandelli F. Sirchia G.

Institution: Centro Trasfusionale e di Immunologia dei Trapianti, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore, Milan, Italy.

Title: The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto.[see comment].

Comments Comment in: N Engl J Med. 1997 Dec 25;337(26):1914-5; PMID: 9407160, Comment in: N Engl J Med. 1998 May 14;338(20):1468; author reply 1469-70; PMID: 9583978

Source: New England Journal of Medicine. 337(26):1870-5, 1997 Dec 25.

Abstract: BACKGROUND: Prophylactic platelet transfusions are usually administered to patients receiving myelotoxic chemotherapy when their platelet count falls below 20,000 per cubic millimeter. Some observations suggest that lower platelet counts can be appropriate in patients in stable condition, but the safety of lower thresholds is uncertain. METHODS: We evaluated 255 adolescents and adults (age, 16 to 70 years) with newly diagnosed acute myeloid leukemia (but not acute promyelocytic leukemia), who were treated in 21 centers. One hundred thirty-five patients were randomly assigned to receive a transfusion when their platelet count fell below 10,000 per cubic millimeter (or 10,000 to 20,000 per cubic millimeter in those with a temperature above 38 degrees C, with active bleeding, or a need for invasive procedures), and 120 patients were assigned to receive a transfusion when their platelet count was less than 20,000 per cubic millimeter. RESULTS: Patients in the group with a threshold of 10,000 platelets per cubic millimeter received 21.5 percent fewer platelet transfusions than the patients in the group with a threshold of 20,000 platelets per cubic millimeter (P=0.001). The numbers of red-cell units transfused were not significantly different between groups. Major bleeding (defined as any bleeding more than petechiae or mucosal or retinal bleeding) occurred in 21.5 and 20 percent of patients, respectively (P=0.41), and on 3.1 and 2.0 percent of the days of hospitalization. One episode of fatal cerebral hemorrhage occurred in the group with a threshold of 10,000 platelets per cubic millimeter; none occurred in the other group (P= 0.95). Actuarial estimates of survival during induction chemotherapy, actuarial estimates of the absence of major bleeding, and the length of hospital stay were not significantly different in the two groups. CONCLUSIONS: The risk of major bleeding during induction chemotherapy in adolescents and adults with acute myeloid leukemia (except acute promyelocytic leukemia, which we did not study) was similar with platelet-transfusion thresholds of 20,000 per cubic millimeter and 10,000 per cubic millimeter (or 10,000 to 20,000 per cubic millimeter when body temperature exceeded 38 degrees C, there was active bleeding, or invasive procedures were needed). Use of the lower threshold reduced platelet use by 21.5 percent.

Publication Type: Clinical Trial. Journal Article. Multicenter Study. Randomized Controlled Trial.

<14>

Unique Identifier [PMID]: 9060557

Authors: Heckman KD. Weiner GJ. Davis CS. Strauss RG. Jones MP. Burns CP.

Institution: Department of Medicine, The University of Iowa College of Medicine, Iowa City 52242, USA.

Title: Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL.

Source: Journal of Clinical Oncology. 15(3):1143-9, 1997 Mar.

Abstract: PURPOSE: We designed and conducted a randomized single-institution trial comparing two common prophylactic platelet transfusion thresholds in patients undergoing induction therapy for acute leukemia. PATIENTS AND METHODS: Seventy-eight patients undergoing induction therapy for acute leukemia were randomized to receive prophylactic apheresis platelet concentrates when the platelet count was either < or = 10,000/microL or < or = 20,000/microL. RESULTS: There was no significant difference in the total number of bleeding episodes per patient with a median of four in the < or = 10,000/microL arm and two in the < or = 20,000/microL arm (25th to 75th percentiles of 2, 7 and 1, 5, respectively; P = .12). Patients randomized to the < or = 10,000/microL arm received more platelet transfusions for bleeding [one (0, 2) v zero (0, 0); P = .0003]. In contrast, patients on the < or = 20,000/microL arm received more platelet transfusions for prophylactic indications [10 (5, 14) v six (3, 8); P = 0.001], as would be expected, but less for bleeding. Nevertheless, the total number of platelet transfusions given to patients on the < or = 20,000/microL arm was higher and nearly significant [11 (6, 15) v seven (5, 11); P = .07]. There were no statistically significant differences between the groups with regard to RBC transfusion requirements, febrile days, days hospitalized, days thrombocytopenic, need for HLA-matched platelets, remission rate, or death during induction chemotherapy. No patient in either group died from hemorrhage or underwent major surgery for bleeding complications. CONCLUSION: Giving prophylactic platelets at a threshold of < or = 10,000/microL compared with < or = 20,000/microL can decrease the total utilization of platelets with only a small adverse effect on bleeding, and no statistically significant effect on morbidity.

Publication Type: Clinical Trial. Journal Article. Randomized Controlled Trial.

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Unique Identifier [PMID]: 8136604

Authors: Heddle NM.

Institution: Department of Pathology, McMaster University, Hamilton, Ontario, Canada.

Title: The efficacy of leukodepletion to improve platelet transfusion response: a critical appraisal of clinical studies. [Review] [37 refs]

Source: Transfusion Medicine Reviews. 8(1):15-28, 1994 Jan.

Publication Type: Journal Article. Review.