Prophylactic platelet transfusion did not reduce bleeding

January 01, 0001

Prophylactic platelet transfusion did not reduce bleeding

These US investigators conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. They randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x1011, 2.2x1011, or 4.4x1011 platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria).

They found: "In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25x1011) than in the medium-dose group (11.25x1011) or the high-dose group (19.63x1011), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter."

The authors concluded: "Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1x1011 and 4.4x1011 platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding."

These results support usual practice of not transfusing platelets prophylactically.

For the full abstract, click here.

N Engl J Med 362(7):600-613, 18 February 2010 © 2010 to the Massachusetts Medical Society
Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage. Sherrill J. Slichter, Richard M. Kaufman, Susan F. Assmann, et al. Correspondence to Dr. Schlichter: [email protected]

Category: B. Blood/Blood Forming Organs/Immune Mechanisms. Keywords: platelets, transfusion, thrombocytopenia, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.