Abstract
Thirty years ago platelet transfusions were not available. Thrombocytopenic bleeding led to morbidity and mortality in patients with aplastic anemia and hematologic malignancies. Now, platelet transfusions generally are as available as any physician wishes. This ready availability and the development of potent antibiotics have allowed hematologists and oncologists to employ increasingly aggressive chemotherapy and radiotherapy in the treatment of a wide variety of malignancies. This in turn has dramatically increased the size of the pool of thrombocytopenic candidates for platelet transfusion. Unfortunately, as this pool expands, the pool of physicians who cared for patients without having platelet transfusions available shrinks. Collectively, we do not remember who really needs a platelet transfusion and who does not. In this issue ofTHE JOURNAL, McCullough et al1estimate that our annual national expenditure for platelet transfusion therapy is approximately $100 million. We should ask how much of this money is well spent
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