Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation

Abstract

In people with haematological disorders who are thrombocytopenic due to myelosuppressive chemotherapy or HSCT, we found low-quality evidence that a standard trigger level (10 x 10(9)/L) is associated with no increase in the risk of bleeding when compared to a higher trigger level (20 x 10(9)/L or 30 x 10(9)/L). There was low-quality evidence that a standard trigger level is associated with a decreased number of transfusion episodes when compared to a higher trigger level (20 x 10(9)/L or 30 x 10(9)/L).Findings from this review were based on three studies and 499 participants. Without further evidence, it is reasonable to continue with the current practice of administering prophylactic platelet transfusions using the standard trigger level (10 x 10(9)/L) in the absence of other risk factors for bleeding.

Blood use in hematologic malignancies: a nationwide overview in Sweden between 2000 and 2010

“…For instance, it has been reported that up to twothirds of all platelet (PLT) transfusions are administered to hematologic patients, including patients with nonmalignant conditions. 1 At the same time, there is a paucity of randomized controlled trials investigating the optimal use of red blood cells (RBCs) in hematologic malignancies. 2 There is also limited understanding of how transfusion patterns vary between different hematologic malignancies and between different age groups.…”

A physiologically based pharmacokinetic and pharmacodynamic (PBPK/PD) model of the histone deacetylase (HDAC) inhibitor vorinostat for pediatric and adult patients and its application for dose specification

“…In part 2 of the in silico trials, the lower thrombocyte limit was set to 50*10 9 cells/l (part 1: 193*10 9 cells/l since platelet counts ≥ 50*10 9 cells/l typically do not lead to clinical interventions, for instance, prophylactic platelet transfusions are recommended for thrombocyte counts of ≤ 10*10 9 cells/l [67]. The upper vorinostat dose limit of 3000 mg was defined by two factors.…”

Factors related to the outcome of prophylactic platelet transfusions in patients with hematologic malignancies: an observational study

“…However, low‐dose transfusion strategies lead to an increased number of PC transfusions and an increased number of PCs per patient . The consequences of such strategies in terms of transfusion reactions, the development of human WBC antibodies, and cost are still unknown …”

“…[26][27][28][29] The consequences of such strategies in terms of transfusion reactions, the development of human WBC antibodies, and cost are still unknown. 30 Patients with anaphylactic reactions to transfusion require washed PCs. In our study, platelet washing had a major influence on CCI and TI criteria.…”