A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation

Wandt, Hannes; Schaefer‐Eckart, Kerstin; Frank, Markus H.; Birkmann, Josef; Wilhelm, Martin

doi:10.1038/sj.bmt.1705246

Cited by 82 publications

(69 citation statements)

References 20 publications

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“…The latter strategy has been documented to be safe in a select group of patients: those undergoing autologous peripheral blood stem cell transplantations. 20 In this study, the need for plt transfusions was reduced by as much as 50% when transfusions were given only for active bleeding.…”

Section: Indications For Plt Transfusionsmentioning

confidence: 89%

Evidence-Based Platelet Transfusion Guidelines

Slichter¹

2007

Hematology

230

173

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Transfused platelets (plts) are either pooled random-donor platelet (plt) concentrates or single-donor apheresis plts. When stored for 5 days, all of these products are equally efficacious.A 10,000/μL prophylactic plt transfusion trigger has been documented to be both hemostatically efficacious and cost effective in reducing plt transfusion requirements. The optimal plt dose/transfusion is being evaluated in an ongoing clinical trial. Therapeutic plt transfusions to control or prevent bleeding with trauma or surgical procedures require higher transfusion triggers of 100,000/μL for neurosurgical procedures and between 50,000/μL and 100,000/μL for other invasive procedures or trauma.Leukoreduction has been documented to reduce plt alloimmunization rates, cytomegalovirus (CMV) transmission by transfusion, and febrile transfusion reactions. Whether it reduces immunomodulatory effects of transfusion (i.e., decreases infection rates and cancer recurrence) is still controversial, as is universal leukoreduction.Poor responses to plt transfusions are often multifactorial. For alloimmune plt refractoriness, HLA matching, cross-matching, and identification of the specificity of the patient’s antibodies with avoidance of mismatched donor antigens are all equally effective in identifying compatible plts for transfusion. Other causes of poor plt responses are splenomegaly, ABO mismatching, females with 2 or more pregnancies and males, use of heparin or amphotericin, bleeding, fever, graft-vs-host disease (GVHD), and vaso-occlusive disease (VOD).

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Section: Indications For Plt Transfusionsmentioning

confidence: 89%

Evidence-Based Platelet Transfusion Guidelines

Slichter¹

2007

Hematology

230

173

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“…13,14 Recently, use of therapeutic vs prophylactic transfusion has been espoused, but some TBIcontaining regimens required more transfusions because of mucositis when transfusions were utilized only for symptoms or bleeding. 15 Other groups have also found faster engraftment but more gastrointestinal bleeding with this approach. 16 Previous retrospective studies have shown that CD34 þ cell counts in the graft, platelet counts at start of conditioning, local radiation and fever all influence time to platelet recovery.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Liesveld

Pawlowski

Chen

et al. 2012

Bone Marrow Transplant

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Successful utilization of SCT modalities often requires utilization of both red cell and platelet transfusions. In this retrospective evaluation of clinical factors affecting transplant engraftment and transfusion utilization at a single transplant center in 505 patients from 2005 through 2009, we found that graft type, donor type and the conditioning regimen intensity significantly affected both the neutrophil engraftment time (Po0.001) and the platelet engraftment time (Po0.001). SCT patients required an average of 6.2 red cell units, and 7.9 platelet transfusions in the first 100 days with a wide s.d. Among auto-SCT patients, 5% required neither RBC nor platelet transfusions. Some reduced-intensity transplants were also associated with no transfusion need, and in allogeneic transplants, conditioning regimen intensity was positively correlated with platelet transfusion events as assessed by multivariate analysis. Other patient characteristics such as gender, graft type, donor type, underlying disease and use of TBI were all independently associated with transfusion needs in SCT patients. Further studies are required to understand the means to minimize transfusions and potential related complications in SCT patients.

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“…17 Thus, the overall benefit of a prophylactic platelet transfusion policy over a policy to use platelets only therapeutically is not well established. It is important to note that there are now some data, albeit observational, to suggest that a treatmentbased platelet transfusion strategy may indeed be safe and effective in clinical practice.…”

Section: Prophylactic Platelet Transfusionsmentioning

confidence: 99%

“…This is exemplified by the results of a recent study of therapeutic platelet transfusions in hematopoietic stem cell autograft patients in Germany. 17 It is also possible that patient selection may be the key to the safety of therapeutic only-based platelet transfusion.…”

Section: Prophylactic Platelet Transfusionsmentioning

confidence: 99%

Platelet Transfusion Therapy

Karim

Hoque²,

Hoque

et al. 2017

Anwer Khan Mod Med Coll J

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Patients with severe thrombocytopenia are presumed to be at increased risk for bleeding, and consequently it has been standard practice for the past four decades to give allogeneic platelet transfusions to severely thrombocytopenic patients as supportive care. Platelet transfusions may be given either prophylactically to reduce the risk of bleeding, in the absence of clinical hemorrhage (prophylactic transfusions), or to control active bleeding when present (therapeutic transfusions). Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood, which are pooled before administration, or by apheresis from single donors. Comparative studies have shown that the post transfusion increments, hemostatic benefit, and side effects are similar with either product. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are preferred when histocompatible platelet transfusions are needed. Both preparations can be stored for up to 5 days after collection at 20°C to 24°C with good maintenance of platelet viability. It is now uncommon for patients undergoing intensive chemotherapy or bone marrow transplantation to die of hemorrhage, but it is open to debate as to what degree platelet transfusions have been responsible for this change in outcome, given the many other advances in other aspects of supportive care.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 40-46

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A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation

Cited by 82 publications

References 20 publications

Evidence-Based Platelet Transfusion Guidelines

Evidence-Based Platelet Transfusion Guidelines

Clinical factors affecting engraftment and transfusion needs in SCT: a single-center retrospective analysis

Platelet Transfusion Therapy

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