Today we will discuss prophylactic platelet transfusions in patients with hematologic diseases.
Platelet transfusions have been used for almost 50 years to help treat patients with hematologic and oncologic diseases with thrombocytopenia, especially when platelet counts fall below 10,000 per microliter. A recent randomized trial conducted in the United Kingdom and Australia found that prophylactic platelet transfusions were associated with a reduced risk of WHO Grade 2 to 4 bleeding in hematologic cancer patients compared to those receiving therapeutic transfusions. A follow-up analysis of this trial recently published in TRANSFUSION examined the benefits of prophylactic platelet transfusions for different subgroups of patients.
Dr. Simon Stanworth, who led the study, explains:
“We wanted to try to see whether there were differences here for those patients, particularly those undergoing auto transplantation versus those undergoing more intensive chemotherapy or allotransplant.”
Dr. Stanworth and his team found that patients with hematologic malignancies receiving either chemotherapy or allogeneic hematopoietic stem cell transplants benefited from prophylactic platelet transfusions. Only 38% of these patients had WHO Grade 2 to 4 bleeding compared to 58% of the patients not receiving prophylactic transfusions. These same patients receiving prophylactic transfusions also had longer time to their first Grade 2 bleed.
Dr. Schiffer, who wrote a commentary on the article, summarizes study results for autologous hematopoietic stem cell transplant patients:
“I think the most important part of it is that in patients receiving autologous stem cell transplant there was no difference in outcome between those who received prophylactic transfusion and those who receive so called therapeutic transfusions.”
This study found that prophylactic platelet transfusions are not always necessary for patients undergoing autologous hematopoietic stem cell transplants. These patients are usually in remission at the time of transplant and have shorter periods of thrombocytopenia.
Dr. Stanworth adds:
“It is making us as clinicians think more about which patients really benefit from transfusions and which perhaps don’t benefit as much. We need to be thinking and understanding better about the risk factors for bleeding and individualizing those patient that need platelet transfusions for maximal benefit.”
We’ll be back with another edition of Transfusion News on October 30th. Thanks for joining us.
2. Stanworth SJ, Estcourt LJ, Llewelyn CA, Murphy MF, Wood EM, Investigators TS. Impact of prophylactic platelet transfusions on bleeding events in patients with hematologic malignancies: a subgroup analysis of a randomized trial. Transfusion 2014;54:2385-2393.
Transfusion offers CME credit for this study! Log on at www.wileyhealthlearning.com/trf.