Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 × 10⁹ or 20 × 10⁹ per L

Abstract

The 10 x 10(9) per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 x 10(9) per L trigger should be more thoroughly evaluated.

The clinical impact of platelet refractoriness: correlation with bleeding and survival

“…Exposure to profound thrombocytopenia was significantly increased when a restrictive prophylactic threshold was used. A relation with increased PLT consumption due to endothelial damage was argued 13 . These findings underline the need for the identification of more specific risk factors for the occurrence of thrombocytopenia, bleeding, and survival, to improve supportive care strategies 14,15 .…”

A review of transfusion practice before, during, and after hematopoietic progenitor cell transplantation

“…Guidelines for transfusing pancytopenic patients with erythrocytes, platelets, or plasma are well established and are usually extended by inference to HPC patients because data on this population are lacking. [57][58][59][60][61] Because hematopoiesis is expected to be decreased during this phase, replacement transfusion may be intensive, especially if active bleeding occurs. 9,62 …”

“…60 Therefore, conventional thresholds or "triggers" (eg, platelet count of 10 000/L) for initiating platelet transfusions in HPC transplantation recipients 57,58 are used by most centers. Bleeding in HPC patients is probably multifactorial, reflecting the active complications of HPC transplantation, such as mucositis, hemorrhagic cystitis, GVHD, VOD, and diffuse alveolar hemorrhage (DAH).…”

“…Bleeding in HPC patients is probably multifactorial, reflecting the active complications of HPC transplantation, such as mucositis, hemorrhagic cystitis, GVHD, VOD, and diffuse alveolar hemorrhage (DAH). 58,60,63 Therefore, considering the patient's clinical situation as the "trigger" to initiating a platelet transfusion is recommended.…”

“…Sometimes, simply increasing the platelet dose administered will improve posttransfusion platelet counts. 60 However, HLA-matched or crossmatched apheresis platelets may be required for satisfactory responses. To accurately document the need for an HLA antibody workup and for more specialized platelet matching, a 30-minute postplatelet transfusion count is usually necessary.…”