Clinical effectiveness and comparative hospital costs of different platelet dose strategies.

Abstract

Platelet transfusion plays a vital role in the support of numerous medical treatments in general and specifically in the care of patients with haematological and solid organ malignancies1. In addition to the supply of platelets being limited, platelet transfusion is a financially burdensome procedure. Indeed, platelet transfusion has long been the subject of many debates and controversies including the advantage of giving prophylactic compared to therapeutic transfusion, the trigger and/or threshold for platelet transfusion, the platelet collection method, and the optimal platelet dose to transfuse2–4. In 1973, Roy et al. demonstrated that a standard-dose platelet transfusion can be safely given instead of a higher platelet dose without increasing the incidence of bleeding and since then many investigators have tried to examine the possibility of giving even lower dose platelet transfusions5. In 1985, Hanson et al. demonstrated through a mathematical model that in order to maintain haemostasis a person needs nearly 7,000 platelets/μL6. There are no true guidelines regarding platelet transfusion dose but the current dose which has been suggested is 0.5×1011/10 kg for children (equivalent to one whole blood-derived platelet concentrate) and 3.0×1011 in adults (which is equivalent to one plateletpheresis collection or sixunits of whole blood buffy coat-derived platelet concentrate)7–9. The AABB and the Council of Europe require that an apheresis unit contains ≥3.0×1011 and ≥2.0×1011 in more than 90 % of units, respectively10,11. Currently, many haematologists and oncologists prefer to transfuse their patients with high doses of platelets in order to avoid high-grade bleeding with the postulation that a high dose will result in less frequent transfusions and improved outcome. The low-dose strategy was shown by Riley to be less costly than using a standard or high dose12; however, the study in which this was demonstrated only involved inpatients without taking into consideration outpatients who can have a huge impact on costs12,13. Many studies have focused on the incidence of bleeding as the primary outcome when investigating different dose strategies, but few have studied platelet characteristics following the same dose strategies. This research is not based on a systematic review. We searched Pubmed, Medline and Embase up to July 2013 using the following terms alone and in combinations: platelet, platelet transfusion, platelet dose, platelet transfusion cost and platelet characteristics. We identified nine trials but one had to be excluded because it was an abstract and could not be studied thoroughly14. The primary purpose of this review was to try to determine the effect of platelet dose on post-transfusion platelet characteristics in terms of number of transfusions used, post-transfusion platelet count increment and the number of days to next transfusion. We also collected information from studies that performed cost analyses and tried to reach to a conclusion concerning the optimal platelet dose for transfusion in relation to the cost.