The Threshold for Prophylactic Platelet Transfusions in Adults with Acute Myeloid Leukemia

Rebulla, Paolo; Finazzi, Guido; Marangoni, Francesca; Avvisati, Giuseppe; Gugliotta, Luigi; Tognoni, Gianni; Barbui, Tiziano; Mandelli, F; Sirchia, G.

doi:10.1056/nejm199712253372602

Cited by 546 publications

(465 citation statements)

References 19 publications

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“…One very successful maneuver was simply lowering the transfusion trigger for prophylactic platelet transfusion from 20,000/ µL to 10,000/µL. This change, found to be safe in a number of studies, 39,40 is thought to have reduced the number of platelet doses transfused in the US by 20-30%, 41 although no large-scale studies have been performed to determine the actual impact of the altered transfusion threshold. A complementary approach to lowering the trigger is altering the dose of prophylactic platelets provided.…”

Section: Platelet Dosingmentioning

confidence: 99%

Platelets: Testing, Dosing and the Storage Lesion—Recent Advances

Kaufman¹

2006

Hematology

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The demand for platelet transfusions continues to grow. Several complementary approaches that may help meet this demand in the future are reviewed. First, platelet bacterial testing is beginning to allow the extension of platelet storage beyond 5 days. Studies are also underway aimed at better preserving viability and function during ex vivo platelet storage: additive solutions and other approaches are being developed to try to negate the "platelet storage lesion." Finally, new approaches to dosing platelets may help extend the limited supply.

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Section: Platelet Dosingmentioning

confidence: 99%

Platelets: Testing, Dosing and the Storage Lesion—Recent Advances

Kaufman¹

2006

Hematology

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“…[1][2][3][4] On the basis of these results, three clinical studies were performed with a 10Â 10 9 /l trigger in recipients of high-dose chemotherapy7total body irradiation (TBI), followed by hematopoietic stem cell support. [5][6][7] All three studies proved the safety of the 10 Â 10 9 /l trigger for prophylactic platelet transfusion after autologous bone marrow or peripheral blood stem cell transplantation (PBSCT).…”

Section: Introductionmentioning

confidence: 99%

A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation

Wandt

Schaefer‐Eckart

Frank

et al. 2006

Bone Marrow Transplant

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Prophylactic platelet transfusions are considered as standard in most hematology centers, but there is a long-standing controversy as to whether standard prophylactic platelet transfusions are necessary or whether this strategy could be replaced by a therapeutic transfusion strategy. In 106 consecutive cases of patients receiving 140 autologous peripheral blood stem cell transplantations, we used a therapeutic platelet transfusion protocol when patients were in a clinically stable condition. Platelet transfusions were only used when relevant bleeding occurred (more than petechial). Median duration of thrombocytopenia o20 Â 10 9 /l and o10 Â 10 9 /l was 6 and 3 days, which resulted in a total of 989 and 508 days, respectively. In only 26 out of 140 transplants (19%), we observed clinically relevant bleeding of minor or moderate severity. No severe or lifethreatening bleeding was registered. The median and mean number of single donor platelet transfusions was one per transplant (range 0-18). One-third of all transplants, and 47% after high-dose melphalan could be performed without any platelet transfusion. Compared with a historical control group, we could reduce the number of platelet transfusions by one half. This therapeutic platelet transfusion strategy can be performed safely resulting in a considerable reduction in prophylactic platelet transfusions.

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“…Based on PCs in EDTA-samples, 15 patients (16%) shifted from a lower bleeding risk at t 0 to a higher bleeding risk category at t 90 (P 5 0.019), compared to 5 (5%) patients, based on PCs in CPT-samples. Therefore, time-dependent in vitro platelet agglutination in EDTA-blood samples may cause underestimation of PCs in thrombocytopenic patients, possibly leading to improper management.The accuracy of PC measurement is important for the diagnosis [1-5] and management [6][7][8][9][10][11] of patients with thrombocytopenia. Spuriously low PC is observed in 0.07-0.27% of blood samples [12][13][14] owing to the presence of antibodies that cause a time-dependent in vitro platelet agglutination.…”

mentioning

confidence: 99%

“…The accuracy of PC measurement is important for the diagnosis [1][2][3][4][5] and management [6][7][8][9][10][11] of patients with thrombocytopenia. Spuriously low PC is observed in 0.07-0.27% of blood samples [12][13][14] owing to the presence of antibodies that cause a time-dependent in vitro platelet agglutination.…”

mentioning

confidence: 99%

The platelet count in EDTA‐anticoagulated blood from patients with thrombocytopenia may be underestimated when measured in routine laboratories

Podda¹,

Pugliano²,

Femia³

et al. 2012

American J Hematol

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Spuriously low platelet counts (PCs) can be observed in normal blood samples anticoagulated with ethylenediamine tetra-acetic acid (EDTA) and, much less frequently, with citrate-tris-pyridossalphosphate (CPT), due to time-dependent in vitro platelet agglutination. Accuracy in PC determination is essential as PC is one of the parameters that usually guides treatment for thrombocytopenic patients. PCs of 93 thrombocytopenic patients were measured in EDTA-or CPT-anticoagulated blood samples immediately after sampling (t 0 ) and 90 min (t 90 ) after storage at room temperature. The presence of platelet agglutinates in blood samples was determined by examining blood smears using optical microscopy. PCs decreased at t 90 with both anticoagulants. Platelet agglutinates were present at t 90 in 27% of EDTA-samples vs. 2% of CPT-samples with decreased PCs (P < 0.001). Based on PCs in EDTA-samples, 15 patients (16%) shifted from a lower bleeding risk at t 0 to a higher bleeding risk category at t 90 (P 5 0.019), compared to 5 (5%) patients, based on PCs in CPT-samples. Therefore, time-dependent in vitro platelet agglutination in EDTA-blood samples may cause underestimation of PCs in thrombocytopenic patients, possibly leading to improper management.The accuracy of PC measurement is important for the diagnosis [1-5] and management [6][7][8][9][10][11] of patients with thrombocytopenia. Spuriously low PC is observed in 0.07-0.27% of blood samples [12][13][14] owing to the presence of antibodies that cause a time-dependent in vitro platelet agglutination. This harmless condition, termed ''pseudothrombocytopenia,'' is particularly common in blood samples collected in EDTA anticoagulant, which is used in routine laboratories for blood cell counts [12][13][14]. The use of other anticoagulants, such as citrate-tris-pyridoxalphosphate (CPT), prevents this phenomenon in some, albeit not all instances [15][16][17][18]. We hypothesized that the artifact responsible for pseudothrombocytopenia could contribute to spuriously decreased PCs also in patients with real thrombocytopenia. We assessed the effect of time elapsed since blood sampling and of the type of anticoagulant on PCs in patients with thrombocytopenia.The median PC in EDTA-anticoagulated blood samples was 58 3 10 9 /L (range, 2-143) immediately after blood sampling (t 0 ) and 55 3 10 9 /L (3-132) 90 min after storage at room temperature (t 90 ) (P 5 0.025). PC was lower in 49 patients (53%) and higher in 34 patients (38%) at t 90 , compared to t 0 (Table I). The frequency of patients with decreased PC was higher than that of patients with increased PC (p 5 0.04). At t 90 , platelet agglutinates in EDTA-blood smears were present in 27% of patients who exhibited a decrease in PC, and in one patient (3%) of those who exhibited an increase of PC (P 5 0.006) ( Table I). The median absolute decrease in PC in EDTAsamples displaying agglutinates at t 90 was 18 3 10 9 /L (10-71) vs. 3 3 10 9 /L (1-32) in those with no platelet agglutinates (P < 0.001). Based on PC in EDTA-samples at...

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The Threshold for Prophylactic Platelet Transfusions in Adults with Acute Myeloid Leukemia

Cited by 546 publications

References 19 publications

Platelets: Testing, Dosing and the Storage Lesion—Recent Advances

Platelets: Testing, Dosing and the Storage Lesion—Recent Advances

A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation

The platelet count in EDTA‐anticoagulated blood from patients with thrombocytopenia may be underestimated when measured in routine laboratories

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