Platelet transfusions administered to patients with splenomegaly

Abstract

It is generally felt that increments in platelet counts following platelet transfusions to patients with splenomegaly are severely reduced as a result of splenic sequestration. The results of 631 random-donor platelet transfusions administered to 66 thrombocytopenic patients with palpable splenomegaly were analyzed. Increasing splenomegaly had a significant effect on corrected count increments (CCIs), with the greatest deterioration occurring in patients whose spleens were palpable greater than 2.0 cm below the left costal margin. A similar trend was noted when the percentage of transfusions with satisfactory CCIs was compared, although it should be noted that 42 percent of the transfusions produced CCIs greater than 7500, and a large proportion produced clinically helpful absolute increments. Splenomegaly also had an effect on platelet survival: in patients with CCIs greater than 7500, the mean ratio of 24-hour CCIs to 1-hour CCIs was 0.29 to 0.47 in patients with various degrees of splenomegaly, as compared to an expected value of 0.6 to 0.7. Sixteen patients, most with spleens palpable less than 5.0 cm below the left costal margin, consistently had CCIs greater than 7500. A significant fraction of patients with splenomegaly can benefit from platelet transfusion, and thus splenomegaly should not preclude intensive therapeutic approaches.

A flow cytometric platelet immunofluorescence crossmatch for predicting successful HLA matched platelet transfusions

“…A transfusion was considered successful when the 1 h post-transfusion platelet recovery was > 20%. At the time of each transfusion the presence or absence of the following conditions that might reduce platelet survival were documented: temperature, septicaemia, splenomegaly, disseminated intravascular coagulation, and major haemorrhage (a decrease of haemoglobin value of 2 mmol/l or more within 24 h) (Bishop et al, 1988(Bishop et al, , 1991McFarland et al, 1989;Hussein et al, 1990;Friedberg et al, 1993;Doughty et al, 1994).…”

Relative Importance of Immune and Non-Immune Causes of Platelet Refractoriness

“…This study provides evidence that immune mechanisms were not the predominant cause of platelet refractoriness in the patient population studied. It also suggests that measures for the prevention of HLA alloimmunisation, such as leucocyte depletion, may have a limited impact in reducing the in cidence of refractoriness to platelet transfusions.bleeding [10][11][12], disseminated intravascular coagulation (DIC) [13,14], and splenomegaly [12,[15][16][17], A multiple linear regression analysis identified the major factors as sociated with refractoriness as splenomegaly, administra tion of amphotericin B, bone marrow transplantation, HLA antibodies and DIC [18].Previous studies have shown that HLA alloimmunisa tion and platelet refractoriness are reduced by the use of leucocyte-depleted blood components [19][20][21][22][23][24][25], However, doubt remains about the cost-effectiveness of leucocyte depletion of blood components for the prevention of pla telet refractoriness [26]. Although leucocyte depletion might prevent refractoriness due to HLA alloimmunisa-…”

Clinical and laboratory factors associated with platelet transfusion refractoriness: a case–control study

“…Splenomegaly has been identified as a cause of platelet refractoriness in many studies (Parker et al, 1974;Bishop et al, 1988;Hussein et al, 1990). In our series there were few patients with splenomegaly, which may account for the lack of statistical significance in the multivariate analysis.…”