Prophylactic Platelet Transfusion Threshold Research Articles

Association between the development of bronchopulmonary dysplasia and platelet transfusion: a protocol for a systematic review and meta-analysis.

There is a lack of consensus on the management of thrombocytopenia in preterm infants, and the threshold for prophylactic platelet transfusion varies widely among clinicians and institutions. Reports in animal models suggested that platelets may play a relevant role in lung alveolarization and regeneration. Bronchopulmonary dysplasia (BPD) is a severe respiratory condition with a multifactorial origin that affects infants born at the early stages of lung development. Recent randomized controlled trials on the platelets count threshold for prophylactic transfusions in preterm infants with thrombocytopenia suggest that a higher exposition to platelet transfusion may increase the risk of BPD. Here, we report a protocol for a systematic review, which aims to assist evidence-based clinical practice and clarify if the administration of platelet products may be associated with the incidence of BPD and/or death in preterm infants. MEDLINE, Embase, Cochrane databases, and sources of gray literature for conference abstracts and trial registrations will be searched with no time or language restrictions. Case-control studies, cohort studies, and nonrandomized or randomized trials that evaluated the risk for BPD and/or death in preterm infants exposed to platelet transfusion will be included. Data from studies that are sufficiently similar will be pooled as appropriate. Data extraction forms will be developed a priori. Observational studies and nonrandomized and randomized clinical trials will be analyzed separately. Odds ratio with 95% confidence interval (CI) for dichotomous outcomes and the mean difference (95% CI) for continuous outcomes will be combined. The expected heterogeneity will be accounted for using a random-effects model. Subgroup analysis will be performed based on a priori-determined covariate of interest. In case of sufficient homogeneity of interventions and outcomes evaluated, results from subgroups of studies will be pooled together in a meta-analysis. This systematic review will investigate the association of BPD/death with platelet components administration in preterm infants, and, consequently, it will provide reliable indications for the evidence-based management of premature patients with thrombocytopenia.

Two-year outcomes following a randomised platelet transfusion trial in preterm infants

ObjectiveAssess mortality and neurodevelopmental outcomes at 2 years of corrected age in children who participated in the PlaNeT-2/MATISSE (Platelets for Neonatal Transfusion - 2/Management of Thrombocytopenia in Special Subgroup) study,...

British Society for Haematology Guidelines on transfusion for fetuses, neonates and older children (Br J Haematol. 2016;175:784-828). Addendum August 2020.

Following publication of the British Society for Haematology (BSH) transfusion guidelines for fetuses, neonates and older children,1 there have been a number of changes requiring this addendum, prior to full revision of the guideline. For each update in the addendum, the relevant section number in the main guideline is given. The PlaNeT-2/MATISSE study was a multicentre randomised controlled trial of prophylactic platelet transfusions in preterm neonates (660 babies, <34 weeks’ gestation). The results showed that babies with severe thrombocytopenia randomised to receive platelet transfusions to maintain a platelet count threshold of 50 × 109/l had a significantly higher rate of mortality or major bleeding within 28 days of randomisation than those transfused to maintain a platelet count threshold of 25 × 109/l.2 The possible reasons for this evidence of harm of platelet transfusions are not clear and are the subject of further investigation.3 The PlaNeT-2/MATISSE results support strengthening the current BSH guideline restrictive recommendation on prophylactic platelet transfusion thresholds. New additional wording is shown in italics: For preterm neonates with very severe thrombocytopenia (platelet count below 25 × 109/l) platelet transfusions should be administered in addition to treating the underlying cause of the thrombocytopenia (2C). For non-bleeding neonates platelet transfusions should not be routinely administered if platelet count is ≥25 × 109/l (1B). Suggested threshold counts for platelet transfusions in different situations are given in Table 2 (2C). The requirement to import plasma for treatment of individuals born on or after 1 January 1996 or with TTP was introduced in 2004 in the UK, as part of variant Creuzfeldt–Jacob disease (vCJD) risk reduction measures. In September 2019, the Department of Health and Social Care withdrew this requirement and approved the use of UK-sourced plasma and pooled platelets for these individuals (https://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2019-09-09/HCWS1821/). This followed publication of advice and a comprehensive updated assessment of the vCJD risk by the Advisory Committee for the Safety of Blood, Tissues and Organs (SaBTO) (https://www.gov.uk/government/publications/risk-reduction-measures-for-variant-creutzfeldt-jakob-disease-pcwg-report). For details on the use of plasma for treatment of patients with TTP also refer to the relevant BSH guideline.4 The Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) subsequently agreed that UK plasma for those born on or after 1 January 1996 does not need to be pathogen inactivated, similar to UK plasma for all other age groups (Oct 2019, https://www.transfusionguidelines.org/about/minutes-of-jpac-meetings). Helen V. New and Simon J. Stanworth wrote the initial manuscript, all authors critically reviewed it and approved the final version. We gratefully acknowledge the comments of the BSH Transfusion Task Force and review by paediatric haematology and neonatology expert colleagues.

Fecal blood loss: A quantitative method of evaluating hemostasis in patients with thrombocytopenia.

The purpose of our studies was to determine if fecal blood loss can provide a quantitative measure of bleeding at platelet counts of 20 000/μL or less in patients with hypoproliferative thrombocytopenia and to document the effects of different prophylactic platelet transfusion triggers on fecal blood loss. Patients had an aliquot of their autologous red blood cells (RBCs) labeled with 51 Cr. Following reinjection of their radiolabeled RBCs, all feces and a daily blood sample were collected to determine fecal blood loss per day. Three different studies were performed in patients with thrombocytopenia: The first was in patients with thrombocytopenia with aplastic anemia who were not receiving platelet transfusions, and the other two trials involved thrombocytopenic patients with cancer who were receiving prophylactic platelet transfusions at platelet transfusion triggers of 5000/μL, 10 000/μL, or 20 000/μL. In patients with thrombocytopenia not receiving platelet transfusions, fecal blood loss does not increase substantially until platelet counts are 5000/μL or less. When platelet transfusions are given prophylactically to patients with cancer with chemotherapy-induced thrombocytopenia at platelet counts of 5000/μL or less, fecal blood loss and red cell transfusion requirements are the same as those for patients transfused prophylactically at higher transfusion triggers of 10 000 platelets/μL or 20 000 platelets/μL. However, the total number of platelet transfusions needed increases significantly, and the duration of the patient's thrombocytopenia tends to be longer at the higher platelet transfusion thresholds. A prophylactic platelet transfusion threshold of 5000/μL or greater is sufficient to maintain hemostasis in patients with thrombocytopenia.

Trends in platelet distributions from 2008 to 2017: a survey of twelve national and regional blood collectors.

This multi-national study evaluated changes in platelet (PLT) unit distributions at 12 national or regional blood collectors over a 10-year period. Data on the total number of PLT distributions, the collection method, that is apheresis vs whole blood-derived (WBD), the PLT unit characteristics and post-collection modifications were obtained from 12 national or regional blood collectors from 2008 through 2017. Individual WBD PLT units were converted to apheresis equivalent units (i.e. a dose of PLTs) by dividing by 4, the typical pool size; WBD units that were pooled before distribution were counted as a single dose. Overall at these 12 blood collectors, the total number of PLTs distributed in 2008 was 1373200, which rose by 10·2% to 1513803 in 2017. The Japanese Red Cross, which distributes only apheresis PLTs, had a 13·4% increase in the number of distributions between the years 2008 and 2017, while the other 11 blood collectors combined demonstrated a 6·8% increase in distributions between these two years. Between the years 2008 and 2017, the changes in the proportion of apheresis, platelet-rich plasma and buffy coat PLT distributions were -29·9%, -70·7% and 80·0%, respectively. The number of PLT distributions increased during the 10-year study period despite prophylactic PLT transfusion thresholds having remained fairly consistent over the last decade. Perhaps this increase is in part driven by increased administration of platelets to patients with massive haemorrhage or an increase in stem cell transplantation. The use of buffy coat PLTs is increasing at these collectors.

Chemotherapy-induced thrombocytopenia and platelet transfusion in patients with diffuse large B-cell lymphoma.

BackgroundCurrently, the risk factors associated with chemotherapy-induced thrombocytopenia (CIT) in patients with diffuse large B-cell lymphoma (DLBCL) are still undefined. Our study aimed to analyze the effects of risk factors on thrombocytopenia and to identify the threshold for infusion platelets of CIT patients who have received platelet transfusions.MethodsWe conducted a retrospective analysis of 523 patients with DLBCL from 2011 to 2013. The clinical and demographic parameters were extracted, and the risk factors associated with CIT were analyzed. The threshold for platelet transfusions in DLBCL patients with a central venous catheter (CVC) was evaluated.ResultsA total of 227 (43.4%) DLBCL patients had thrombocytopenia, and 63 (12.0%) had thrombocytopenia without concomitant cytopenia. We found that the choice of chemotherapy regimen was positively correlated with thrombocytopenia (P<0.001). The chemotherapy regimens most likely to result in thrombocytopenia were dexamethasone, cytarabine, cisplatin (DHAP) (92.3%), isophosphamide, carboplatin, etoposide (ICE) (89.7%), gemcitabine, dexamethasone, cisplatin (GDP) (89.7%), gemcitabine, and oxaliplatin (Gemox) (69.0%). In addition to these, high lactate dehydrogenase (LDH) (P=0.004) and Ann Arbor stage III/IV (P=0.024) were determined to be risk factors leading to thrombocytopenia. Forty patients (17.6%) had transfused platelets, and all of them were placed in the CVC. The high-threshold group (platelet count ≤20×109/L had a significantly lower amount of platelet transfusions than the low-threshold group ≤10×109/L. The platelet transfusion amount was 1.44±0.77 vs. 2.05±1.13 (P=0.047), respectively.ConclusionsThe chemotherapy regimens of DHAP, ICE, GDP, and Gemox can easily lead to thrombocytopenia. A high level of LDH in the peripheral blood and Ann Arbor stage III/IV are also associated with risk factors for thrombocytopenia. A 20×109/L prophylactic platelet transfusion threshold value is safer, more effective, and thus a better choice for DLBCL patients with CVC.

Pre-Transplant Baseline Platelet Count and the Number of Peri-HSCT Transfusions Are Associated with an Increased Disease-Free Mortality Rate in a Large Pediatric Cohort

<h3>Introduction</h3> Platelets play a key role in the innate immune system as a source of pro-inflammatory cytokines. Lower platelet counts are associated with higher mortality in hospitalized adults with a variety of diseases, and platelet count <50,000 K/uL on arrival to the intensive care unit in recipients of allogeneic hematopoietic stem cell transplant (HSCT) is associated with decreased survival. Transfusion of platelets is common after HSCT for prevention and management of bleeding. <h3>Objective</h3> We hypothesized that platelet count prior to initiation of conditioning influences post-transplant outcomes, in part by increasing the need for platelet transfusions. <h3>Methods</h3> We retrospectively analyzed 388 patients undergoing first allogeneic HSCT at Cincinnati Children's. The last non-transfused platelet count at the time of admission for HSCT or start of conditioning regimen was considered the baseline platelet count (BPC). Patients transplanted for bone marrow failure syndromes were excluded due to underlying cytopenias. <h3>Results</h3> 35.8% of the cohort was transplanted for malignancy, 45.3% immunodeficiency, 11.6% hemoglobinopathies, and 6.7% genetic conditions. 114/388 patients in the cohort died (29%). Leading cause of death was acute graft-vs-host disease (aGVHD) followed by organ failure, primary disease, infection, and chronic GVHD (Fig 1a). BPC was significantly lower in deceased patients with no difference seen in baseline hemoglobin (Fig 1b). BPC correlated with the number of platelet transfusion by day +14 after HSCT, with a correlation coefficient of -0.49 (p < 0.001). BPC and the number of peri-transplant platelet transfusions were strongly associated with overall survival (OS) and non-relapse mortality (NRM), while baseline absolute neutrophil count (ANC) and conditioning regimen showed no association with OS (Fig 1c, d; Fig 2). Neither BPC nor the number of platelet transfusions influenced the risk for developing thrombotic microangiopathy (TMA) but lower BPC did increase the risk for developing moderate and especially severe GVHD (Fig 2). To investigate if low BPC is simply a marker for more ill and higher risk patient, we analyzed the subcohort of patients with a BPC in the normal range (> 135 K/uL). Lower BPC and the number of platelet transfusions were still associated with the risk for OS and NRM (Fig 3) <h3>Conclusion</h3> In a large cohort, lower BPC but not baseline hemoglobin or ANC are associated with more platelet transfusions and increased risk for NRM and worse OS. While platelet transfusions have previously been implicated in endothelial damage, this effect is independent of TMA risk. BPC is associated with the risk for GVHD, which is the leading cause of death in the cohort, although this appears independent of transfusion burden. Mechanistic studies are ongoing but these data suggest the need for thoughtful consideration of prophylactic platelet transfusion thresholds.

Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death

AbstractThe Platelets for Neonatal Thrombocytopenia (PlaNeT-2) trial reported an unexpected overall benefit of a prophylactic platelet transfusion threshold of 25 × 109/L compared with 50 × 109/L for major bleeding and/or mortality in preterm neonates (7% absolute-risk reduction). However, some neonates in the trial may have experienced little benefit or even harm from the 25 × 109/L threshold. We wanted to assess this heterogeneity of treatment effect in the PlaNet-2 trial, to investigate whether all preterm neonates benefit from the low threshold. We developed a multivariate logistic regression model in the PlaNet-2 data to predict baseline risk of major bleeding and/or mortality for all 653 neonates. We then ranked the neonates based on their predicted baseline risk and categorized them into 4 risk quartiles. Within these quartiles, we assessed absolute-risk difference between the 50 × 109/L- and 25 × 109/L-threshold groups. A total of 146 neonates died or developed major bleeding. The internally validated C-statistic of the model was 0.63 (95% confidence interval, 0.58-0.68). The 25 × 109/L threshold was associated with absolute-risk reduction in all risk groups, varying from 4.9% in the lowest risk group to 12.3% in the highest risk group. These results suggest that a 25 × 109/L prophylactic platelet count threshold can be adopted in all preterm neonates, irrespective of predicted baseline outcome risk. Future studies are needed to improve the predictive accuracy of the baseline risk model. This trial was registered at www.isrctn.com as #ISRCTN87736839.

Neonatal and pediatric platelet transfusions: current concepts and controversies.

In this review, we focus on three specific concepts related to platelet transfusion in the neonatal and pediatric population: choice of transfusion threshold; use of ABO-mismatched platelets; transfusion of pathogen-reduced or inactivated platelets. Recent trials support the use of lower platelet transfusion thresholds (25 000/μl) in preterm neonates, although data is limited to guide transfusion among more mature neonates. In children, there is low-level evidence as to what the prophylactic platelet transfusion threshold should be in many situations of thrombocytopenia, revealing major variability in platelet transfusion practices. Most pediatric guidelines are extrapolated from adult studies with the most evidence in treatment-associated hypoproliferative thrombocytopenia varying between a platelet transfusion threshold of 10 000/μl to 20 000/μl. Although pathogen-reduced platelets may lower the risks of transfusion-transmitted infection, the effects on platelet refractoriness and transfusion burden in this population warrant additional study. Our review highlights recent advances in neonatal and pediatric platelet transfusion and also emphasizes the urgent need for better evidence to guide practice given recent studies showing the potential harms of platelet transfusion, particularly with liberal use.

Different Platelet Count Thresholds to Guide Use of Prophylactic Platelet Transfusions for Patients With Hematological Disorders After Myelosuppressive Chemotherapy or Stem Cell Transplantation.

What is the optimal platelet count threshold for prophylactic platelet transfusions to minimize bleeding, platelet use, and adverse clinical outcomes in thrombocytopenic patients with hematological malignant neoplasms? Maintaining a higher platelet count threshold (≤20 × 109/L or ≤30 × 109/L) was not associated with less bleeding than the current standard (≤10 × 109/L), but required more platelet transfusions (low-quality evidence).

Platelet transfusion goals in oncology patients.

Despite the advances in platelet component preparation and transfusion support over the years, platelet products remain a limited resource due to their short (5 day) shelf life, and therefore their optimal use in the non-bleeding thrombocytopenic patient continue to draw much attention. There have been a number of national and international guidelines for platelet transfusion therapy in patients with hematologic diseases, some within the last 1-2 years that have incorporated key randomized controlled trials (RCTs) which address issues, such as the optimal platelet dose, the most appropriate threshold for prophylactic platelet transfusions, and whether prophylactic platelet transfusions are superior to therapeutic-only platelet transfusion practices for the prevention life-threatening bleeding in patients with hypoproliferative thrombocytopenia. This review highlights key RCTs and recent systematic reviews focused on optimal platelet transfusion therapy in adult and pediatric patients with hypoproliferative thrombocytopenia secondary to chemotherapy or hematopoietic stem cell transplant (HSCT), discuss how recent innovations in platelet component processing may affect transfusion efficiency, and introduce renewed concepts on adjuvant therapies to prevent bleeding in the hypoproliferative thrombocytopenic patient.

Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Bronchoscopy can be done safely in patients with thrombocytopenia

Prophylactic platelet (PLT) transfusions are often administered to patients before bronchoscopy or bronchoalveolar lavage (BAL) to prevent bleeding. There is a paucity of data to validate this approach, with a commonly suggested PLT transfusion threshold of fewer than 50 × 10(9) /L, largely based on expert opinion. We conducted a retrospective study on the incidence of bleeding complications in patients with thrombocytopenia undergoing bronchoscopy. We identified 150 consecutive patients with PLT counts of not more than 100 × 10(9) /L who underwent bronchoscopy and/or BAL from January 2009 to May 2014 at our institution. The British Thoracic Society (BTS) guidelines were used to categorize bleeding associated with bronchoscopy. Infection (40%) was the primary indication for bronchoscopy with BAL. Fifty-eight of 89 (65%) patients with baseline PLT counts of not more than 50 × 10(9) /L received prophylactic transfusions compared to 8% of those with PLT counts of more than 50 × 10(9) /L. The PLT count did not increase to more than 50 × 10(9) /L in many patients who received transfusions. Seventy-two patients had counts of less than 50 × 10(9) /L at the time of bronchoscopy, with 15 patients having counts of less than 20 × 10(9) /L. Only one patient with a PLT count of 61 × 10(9) /L had bleeding that required continuous suctioning but then resolved spontaneously (termed "mild bleeding" by BTS criteria). Bloody lavage that resolved spontaneously without continuous suctioning (termed "no bleeding" by the BTS criteria) was observed in nine (6%) patients. The very low incidence of bleeding complications from bronchoscopy with or without BAL even in patients with PLT counts of not more than 30 × 10(9) /L (no episodes of clinically significant bleeding in 35 patients) demonstrates that bronchoscopy can be done safely in patients with severe thrombocytopenia.

A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.

Interference of blast cell fragments with automated platelet counting.

Automated haematology analysers may inaccurately determine platelet counts in several circumstances. Spuriously elevated automated platelet counts have been reported in some acute leukaemia (AL) cases because of fragmentation of circulating blast cells (pseudoplatelets). Haemorrhagic diathesis is a common manifestation of AL, which is often caused by severe thrombocytopenia. Therefore, overestimation of the actual platelet count in patients with AL can affect its clinical management. We aimed to detect the frequency of pseudoplatelets in patients with AL. Complete blood cell counts were performed on 86 AL patients with three automated analysers (ADVIA 2120, Coulter LH 750 and Sysmex XE-2100D). Platelet counts were also performed by quantitative flow cytometry (QFC). The platelet counts of the automatic analysers were compared to the platelet counts by QFC. Blood smears were checked for the presence of pseudoplatelets. The automated analysers overestimated the platelet count due to the presence of pseudoplatelets in patients with AL. Pseudoplatelets were observed in the blood smears of 11 patients (13%). Three of these patients were near the prophylactic platelet transfusion threshold. Spurious increases in automated platelet counts by blast cell fragments are little known but frequent artefacts that should be ruled out by careful examination of peripheral blood smears.

Platelet transfusion strategy for hematologic cancers.

In patients with hematologic cancers, severe thrombocytopenia frequently develops as a consequence of the disease or its treatment. Platelet transfusions are usually administered as prophylaxis, to increase low platelet counts, and to reduce the risk of bleeding [1, 2]. It has been shown that the threshold for prophylactic platelet transfusions can be reduced from the previous guideline of 20,000 platelets per cubic millimeter to 10,000 per cubic millimeter without increasing the risk [3]. Furthermore, a recent study [4] suggests that a policy of giving platelet transfusion only as treatment for bleeding can become a suitable choice in low-risk adult patients with hematological cancers, although the primary end point of the study was not a relevant outcome such as the reduction in the number of platelet transfusions. Thus, the effectiveness of prophylactic platelet transfusion to prevent bleeding remains unclear.

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Introduction: Neonatal thrombocytopenia is a common and important clinical problem in preterm neonates. A trial assessing clinically relevant outcomes in relation to the different platelet count thresholds used to trigger transfusion has never been undertaken in preterm neonates with severe thrombocytopenia. Objectives: Platelets for Neonatal Transfusion - Study 2 (PlaNeT-2) aims to assess whether a higher prophylactic platelet transfusion threshold is superior to the lower thresholds in current standard practice in reducing the proportion of patients who have a major bleed or die up to study day 28. Methods: PlaNeT-2 is a two-stage, randomised, parallel-group, superiority trial. PlaNet-2 compares clinical outcomes in preterm neonates (<34 weeks' gestation at birth) randomised to receive prophylactic platelet transfusions to maintain platelet counts at or above either 25 × 10⁹/l or 50 × 10⁹/l. The primary outcome measure is the proportion of patients who either die or experience a major bleed up to and including study day 28. A total of 660 infants will be randomised. Results and Conclusions: This trial will help define optimal platelet transfusion support for severely thrombocytopenic preterm neonates by evaluating the risks and benefits of two different prophylactic neonatal platelet transfusion thresholds.

The Influence of Bleeding on Trigger Changes for Platelet Transfusion in Chemotherapy-Induced Thrombocytopenic Patients

Abstract 1260The optimal threshold for prophylactic platelet transfusion in hypoproliferative thrombocytopenic patients has been evaluated in multiple studies involving hematology and oncology patients. For patients without additional risk factors for bleeding, a trigger of 10 × 109/L is now accepted as safe and recommended in different guidelines. In the original studies, platelet transfusion above this trigger was allowed according to variable predetermined risk factors for bleeding. But, no studies have evaluated the clinicians’ decision-making process leading to a change in the trigger for platelet transfusion. We report on the evaluation of trigger change for platelet transfusion following an initial threshold of 10 × 109/L and the relation with the presence of bleeding according to WHO grades and systems. Eighty-patients that were enrolled at University of Minnesota Medical Center for the previously published SPRINT Trial represent the patient population for the current analysis. Seventy-four patients (93%) had a starting trigger for platelet transfusion of 10 × 109/L and the majority (46/74; 62%) had an increase in their trigger during their hospitalization. Adherence to this starting trigger varied widely between treatment groups. Only a minority of patients treated with chemotherapy alone (3/12; 25%) and autologous transplant (6/15; 40%) had a change in their initial trigger of 10 × 109/L in contrast to the majority of allogeneic transplant patients (37/47; 79%) (p=0.001 compared to chemotherapy group and p=0.009 compared to autologous transplant group, respectively). The main reason reported by clinicians for a change after a starting trigger of 10 × 109/L was bleeding (32/46; 70%). However, trigger changes were not associated with more clinically significant bleeding. The occurrence of WHO grade 2–4 bleeding was very similar in patients with a trigger change and patients without a trigger change (51% and 54%; p=1.00). Even when limiting the analysis to trigger changes for a bleeding reason the overall distribution of the highest bleeding grades (WHO grade 0–4) leading to that change was similar to the highest bleeding grades of patients without a trigger change (p=0.205). Clinicians were influenced by the WHO organ system in which bleeding occurred when making their decision whether or not to raise the trigger for platelet transfusion. There was an overrepresentation of grade 1 mucocutaneous bleeding leading to an increase in the trigger (62% of the cases). And, there was an overrepresentation of grade 2 genitourinary bleeding not leading to an increase in the trigger (57% of cases). In conclusion, having a universal trigger of 10 × 109/L for platelet transfusion in hypoproliferative thrombocytopenic patients is probably not adequate because of the diversity of the patient population and their respective bleeding risk factors. Also, these multiple complicating factors for bleeding that lead to trigger changes need better validation to support clinicians in their decision-making process when addressing the optimal trigger for platelet transfusion. Otherwise, a seemingly valid trigger of 10 × 109/L becomes useless if misused or changed for any kind of reasons. Disclosures:No relevant conflicts of interest to declare.

The platelet prophylactic transfusion trigger: when expectations meet reality

The platelet prophylactic transfusion trigger: when expectations meet reality