Platelet transfusions for hematology-oncology patients undergoing chemotherapy or stem cell transplants with hypoproliferative thrombocytopenia are common.
New platelet transfusion guidelines from the International Collaboration for Transfusion Medicine (ICTM) assist specialists in maximizing platelet resources. The ICTM recommends that prophylactic platelet transfusions should be given to chemotherapy or stem cell transplant patients when platelet counts are 10X109/L or lower, or if these patients have significant bleeding. Although lower, more frequent doses of platelets (1.1X1011/m2) were found to be just as effective as higher doses for inpatients, median doses (2.4X1011/m2) may help lower costs and prevent clinic visits for outpatients. The ICTM also recommends using ABO-matched platelets. Women of child bearing potential who are RhD negative should be given Rh immunoglobin if they receive RhD positive platelets. Hypoproliferative thrombocytopenic patients who are refractory to platelet transfusions due to alloimmunization should receive HLA/HPA-selected or cross-matched-selected platelets, although the exact degree of benefit is not clear. These recommendations are in-line with the current AABB guidelines for platelet transfusions that were recently published.
References
1. Dzik S, Murphy MF. Clinical guidelines in transfusion medicine. Transfus Med Rev 2015;29: 1-2.
2. Nahirniak S, Slichter SJ, Tanael S, Rebulla P, Pavenski K, Vassallo R, Fung M, Duquesnoy R, Saw CL, Stanworth S, Tinmouth A, Hume H, Ponnampalam A, Moltzan C, Berry B, Shehata N, International Collaboration for Transfusion Medicine G. Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia. Transfus Med Rev 2015;29: 3-13.
3. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O’Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, and Tobian AAR. Platelet transfusion: a clinical practice guideline from the AABB. Annals of Internal Medicine 2015; 162:205-213.
