Indications for platelet transfusion in patients with thrombocytopenia.

Abstract

Platelet transfusion has become a progressively more common and important therapeutic procedure in managing thrombocytopenic patients. Nevertheless, this therapy continues to evolve. Most platelet products are transfused into non-bleeding thrombocytopenic patients. The transfusion “trigger” or threshold for transfusion of these patients is now generally accepted to be 10,000/μL based on the results of a number of studies. However, it is important to emphasise that this “trigger” value generally applies to uncomplicated patients or those who are not febrile, have no infection, or are not being treated with a drug known to damage platelets. Importantly, even with a platelet “trigger” level established at 10,000/μL, platelet transfusion therapy must be individualised to the patient and the clinical situation. As noted above, fever and infection may be correlated with a greater risk of bleeding, but in addition, minor episodes of bleeding may also increase the subsequent risk of clinically significant bleeding; even haemoglobin concentration may play a role in determining bleeding risk. Finally, although prophylactic platelet transfusion is commonly used in the care of thrombocytopenic patients, therapeutic platelet transfusion may represent a reasonable option in managing the bleeding risk of some thrombocytopenic patients. Certainly in the studies by Wandt et al.26,27 and Stanworth et al.28 the use of therapeutic platelet transfusion resulted in an increased bleeding risk. However, in certain populations of patients, the bleeding seen in the therapeutic transfusion programme is generally mild (WHO bleeding category 2 or less). Nevertheless, the studies have repeatedly highlighted the importance of tailoring platelet transfusions to the clinical needs of each patient. While clinical guidelines for platelet transfusion therapy are reasonably well established, a review of the literature clearly indicates that platelet transfusions must be guided by the population of patients under consideration, the clinical conditions of the patients, and perhaps even the resources of the transfusing facility and its ability to respond rapidly to patients’ transfusion needs.