Continuous platelet drip: a unique approach in the treatment of severe/refractory thrombocytopenia in the pediatric stem cell transplant population

Abstract

Thrombocytopenia is an expected complication of marrow ablative therapy. Platelets are the last hematopoietic cell to ablate and the last to recover after conditioning for tranplant. Bleeding remains a significant cause of morbidity and morality in the immunosuppressed patients. Patients undergoing stem cell transplantation are at greater risk due to the prolonged duration and severe nature of the aplastic period. Therefore, long term supportive care via platelet transfusion is a common and expected therapy in this patient population. As a result of therapy, many patients become refractory to platelet transfusions. These patients may require more intensive measures that include frequent platelet transfusions or continuous platelet drips to prevent complications from bleeding. To further complicate matters, many patients undergoing transplantation are often fluid sensitive and at times fluid restricted. The added volume of multiple platelet transfusions can pose additional risk to an already fragile patient. The use of continuous platelet drips has proven to be an effective way to treat severe/refractory thrombocytopenia and minimize the additional fluid volume. The Duke Pediatric Stem Cell Transplant Unit utilizes continuous platelet drips for select patients. Patients receiving this therapy must meet specific criteria including thrombocytopenia that is refractory despite twice-daily platelet tranfusions and a high risk for bleeding. The purpose of this abstract is to describe the indications, risks, benefits, and nursing challenges associated with continuous platelet drips.