One‐unit compared to two‐unit platelet transfusions for adult oncology outpatients

Abstract

Background and Objectives Platelet dosing has been studied in adult oncology inpatients, but there is almost no published evidence to guide platelet dosing for adult outpatients. We evaluated transfusion indices after 1 unit and 2 unit apheresis platelet transfusions at our hospital to determine whether a benefit to 2‐unit transfusions could be detected. Materials and Methods A retrospective chart review was conducted of all adult oncology patients who received an outpatient platelet transfusion over a 16‐month period (July 2016–November 2017). Pre‐ and post‐transfusion platelet count, and chronology of subsequent platelet transfusions were compared. Results A total of 8467 platelet transfusions were administered to 602 patients during the study period. 59·8% of patients (n = 360) were transfused interchangeably with one or two platelets throughout the study period. The primary study population were comprised of these patients. On average, a 2‐unit platelet transfusions resulted in a higher immediate post‐transfusion platelet count (43 vs. 37 x 103/μl, P < 0·001) and a lower corrected count increment (9707 vs. 14 060, P < 0·001). Transfusion with 2 platelets did not increase the number of days between outpatient transfusions (median; 4 vs. 4, P = 0·959) or the platelet count at the time of next transfusion (11 vs. 11 x 103/μl, P = 0·147). Conclusion Among adult, oncology outpatients that were transfused interchangeably with one or two units of platelets, transfusion with two platelets did not offer a durable improvement in platelet count or impact the subsequent transfusion schedule.

The impact of pathogen‐reduced platelets in acute leukaemia treatment on the total blood product requirement: a subgroup analysis of an EFFIPAP randomised trial

“…Studies of transfusion requirements in acute leukaemia have focused only on one category of blood product and used different endpoints that not allows robust comparison between studies. Criteria reported were, regarding platelet usage, bleeding control or corrected implement count, 1–3,7 or prophylactic or therapeutic strategy, 8,9 and for the RBCs transfusion mainly haemoglobin levels 10–12 …”

“…reported were, regarding platelet usage, bleeding control or corrected implement count, [1][2][3]7 or prophylactic or therapeutic strategy, 8,9 and for the RBCs transfusion mainly haemoglobin levels. [10][11][12] We report blood product requirements during chemotherapy-induced aplasia in a large homogeneous cohort of 395 patients. On average, 2 RBCs and 2-3 PCs were transfused per week.…”

Comparative changes of pre‐operative autologous transfusions and peri‐operative cell salvage in the United States

“…As a result, hospitals have implemented PBM programs to advance restrictive transfusion practices with a view to improve patient outcomes, reduce costs, and conserve blood for transfusion. [40][41][42] Hospitals have implemented PBM programs, and PACS is a part of the PBM initiatives. The peak of the PACS was in 2008 and in general follows the decreasing trend concomitant with decrease in RBC transfusions overall and is concurrent with an increase in adoption of PBM programs.…”

“…There is also evidence validating the improved patient safety afforded by PBM programs, blood conservation techniques (eg, PACS, presurgical hemostasis management, and enhanced and noninvasive surgical techniques) and adherence to transfusion guidelines. As a result, hospitals have implemented PBM programs to advance restrictive transfusion practices with a view to improve patient outcomes, reduce costs, and conserve blood for transfusion 40‐42 . Hospitals have implemented PBM programs, and PACS is a part of the PBM initiatives.…”

Supportive Care for Patients With Myelodysplastic Syndromes

“…29,30 One (vs. 2) apheresed unit transfusion is preferred as 2 units do not increase time between transfusions or platelet count at time of next transfusion due to short-lived effect on the platelet count. 31 Although previous reports suggest the role of antifibrinolytic agents in patients with severe persistent thrombocytopenia, 32 a recent RCT that included MDS patients showed that prophylactic treatment with tranexamic acid did not significantly reduce bleeding in patients receiving therapy. 33 However, the trial did not specifically address patients who are alloimmunized to donor platelets and do not have severe and refractory thrombocytopenia.…”