Platelet Transfusion - Platelet Count Thresholds and Triggers

4/04/00 (Brady)

Group: Tuesday Interns

RE: A 46 year old male with massive hemoptysis.

Question: What is the current thinking on threshold platelet count for prophylactic platelet transfusion to prevent bleeding?

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Unique Identifier: 99133592

Authors: Ancliff PJ. Machin SJ.

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

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]

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Unique Identifier: 97213868

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.

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.