Today we’ll be discussing the PLADO Trial Secondary Analyses.
The Prophylactic Platelet Dose Trial or PLADO study was a large, prospective, randomized trial
evaluating the effect of varied platelet dosing on clinical bleeding among hospitalized hematology
oncology patients.[1]
Two secondary analyses have recently been completed using data from this trial to evaluate the impact of platelet characteristics on clinical bleeding.
The PLADO trial randomized patients to receive low, medium or high doses of prophylactic platelets. The trial found no difference in the incidence of bleeding of grade 2 or higher across study arms.
The study also found that low doses of platelets led to a decreased number of platelets transfused per patient but an increase in the number of transfusions needed.
Notably, the study provides the largest available database on platelet transfusion and bleeding, which permit secondary studies.
Dr. Darrell Triulzi is the lead author of a recent secondary analysis using the PLADO database.[2] He is a professor of pathology at the University of Pittsburgh, medical director of the Institute for Transfusion Medicine, and currently serves as the president of AABB.
The analysis evaluated the impact of platelet transfusion characteristics on post-transfusion platelet increments and clinical bleeding.
Dr. Triulzi noted
(Audio Quote)
“Platelet characteristics such apheresis versus pools, ABO matching, and duration of storage have all been shown to influence platelet increments. What is not clear is whether there is any impact on clinical bleeding.”
The study authors assessed the time to first bleeding by platelet characteristics, such as platelet dose, platelet sources such as apheresis products compared to whole blood pooled concentrates, and platelet storage duration among 778 patients.
Dr. Triulzi went on to explain:
(Audio Quote)
“The study provides strong evidence that these characteristics do not affect the hemostatic effectiveness of platelets for prophylaxis of bleeding in hematology oncology patients. Thus blood banks and clinicians can be reassured that for routine platelet transfusion they can select platelets without regard to these characteristics.”
In addition, a second study[3], by Dr. Cassandra Josephson and colleagues, evaluated bleeding among hospitalized patients enrolled in the PLADO trial stratified by age.
Platelet dose was not predictive of bleeding for any group evaluated. However, children had a higher risk of clinical bleeding than adults.
Further, children had more days of clinical bleeding than adults. These findings suggest that excess bleeding risk among children may be caused by factors other than platelet counts.
Thus, data from the PLADO trial continue to provide many important insights into platelet transfusion and bleeding.
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References:
1. Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, Gernsheimer TB, Ness PM, Brecher ME, Josephson CD, Konkle BA, Woodson RD, Ortel TL, Hillyer CD, Skerrett DL, McCrae KR, Sloan SR, Uhl L, George JN, Aquino VM, Manno CS, McFarland JG, Hess JR, Leissinger C, Granger S. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med 2010;362: 600-13.
2. Triulzi DJ, Assmann SF, Strauss RG, Ness PM, Hess JR, Kaufman RM, Granger S, Slichter SJ. The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia. Blood 2012;119: 5553-62.
3. Josephson CD, Granger S, Assmann SF, Castillejo MI, Strauss RG, Slichter SJ, Steiner ME, Journeycake JM, Thornburg CD, Bussel J, Grabowski EF, Neufeld EJ, Savage W, Sloan SR: Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia. Blood 2012;120:748-760.
