Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia

Abstract

Age-group analyses were conducted of patients in the prophylactic platelet dose trial (PLADO), which evaluated the relation between platelet dose per transfusion and bleeding. Hospitalized patients with treatment-induced hypoproliferative thrombocytopenia were randomly assigned to 1 of 3 platelet doses: 1.1 ؋ 10 11 , 2.2 ؋ 10 11 , or 4.4 ؋ 10 11 platelets/m 2 per transfusion, given for morning counts of < 10 000 platelets/L. Daily hemostatic assessments were performed. The primary end point (percentage of patients who developed grade 2 or higher World Health Organization bleeding) was evaluated in 198 children (0-18 years) and 1044 adults. Although platelet dose did not predict bleeding for any age group, children overall had a significantly higher risk of grade 2 or higher bleeding than adults (86%, 88%, 77% vs 67% of patients aged 0-5 years, 6-12 years, 13-18 years, vs adults, respectively) and more days with grade 2 or higher bleeding (median, 3 days in each pediatric group vs 1 day in adults; P < .001). The effect of age on bleeding differed by disease treatment category and was most pronounced among autologous transplant recipients. Pediatric subjects were at higher risk of bleeding over a wide range of platelet counts, indicating that their excess bleeding risk may be because of factors other than platelet counts. This trial was registered at www. clinicaltrials.gov as #NCT00128713. (Blood. 2012;120(4):748-760)

Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia

“…Similarly, there were no differences in clinically significant bleeding in the 2 studies (Appendix A, Supplementary Table S2) comparing high and standard dose (RR, 1.02; 95% CI, 0.93-1.11) [21]. Although limited, there are data for dosing recommendations in pediatric patients in the PLADO trial, wherein no difference in the likelihood of hemorrhage at low, medium, or high doses was demonstrated [38,42].…”

Laboratory predictors of bleeding and the effect of platelet and RBC transfusions on bleeding outcomes in the PLADO trial

“…[2][3][4][5][6] Other factors may contribute to an increased risk of bleeding in thrombocytopenic patients, including the cause of thrombocytopenia, medications, underlying infection, and sepsis. [7][8][9] Bleeding risk may also be related to coagulation abnormalities 10 and low hematocrits.…”

Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

“…20 However, a subgroup analysis of the study data showed that pediatric patients (range, 0-18 years of age) had a significantly higher risk of grade 2 or higher bleeding than adults across all platelet dose groups. 21 This finding was most pronounced in the pediatric autologous transplant population. 21 Two studies examined the efficacy and safety of prophylactic compared with therapeutic platelet transfusions.…”

“…21 This finding was most pronounced in the pediatric autologous transplant population. 21 Two studies examined the efficacy and safety of prophylactic compared with therapeutic platelet transfusions.…”