A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia

Abstract

Objective: Investigate globally, current treatment patterns, benefit-risk assessments, humanistic, societal and economic burden of platelet transfusion (PT). Methods: Publications from 1998 to June 27, 2018 were identified, based on databases searches including MEDLINE®; Embase and Cochrane Database of Systematic Reviews. Data from studies meeting pre-specified criteria were extracted and validated by independent reviewers. Data were obtained for efficacy and safety from randomized controlled trials (RCTs); data for epidemiology, treatment patterns, effectiveness, safety, humanistic and societal burden from real-world evidence (RWE) studies; and economic data from both. Results: A total of 3425 abstracts, 194 publications (190 studies) were included. PT use varied widely, from 0%-100% of TCP patients; 1.7%-24.5% in large studies (>1000 patients). Most were used prophylactically rather than therapeutically. 5 of 43 RCTs compared prophylactic PT with no intervention, with mixed results. In RWE studies PT generally increased platelet count (PC). This increase varied by patient characteristics and hence did not always translate into a clinically significant reduction in bleeding risk. Safety concerns included infection risk, alloimmunization and refractoriness with associated cost burden. Discussion: In RCTs and RWE studies there was significant heterogeneity in study design and outcome measures. In RWE studies, patients receiving PT may have been at higher risk than those not receiving PT creating potential bias. There were limited data on humanistic and societal burden. Conclusion: Although PTs are used widely for increasing PC in TCP, it is important to understand the limitations of PTs, and to explore the use of alternative treatment options where available.

Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China

“…However, platelet transfusion is not recommended for patients receiving antiplatelet therapy who have cerebral hemorrhage that does not require surgical treatment [167,168]. The use of platelet count as an indication for platelet transfusions has not been shown to improve the outcomes of critical care patients [169,170]. The use of platelet function parameters to guide platelet transfusion in critical care patients with thrombocytopenia may be beneficial for improving the outcomes of these patients [171][172][173].…”

Pretreatment Immature Platelet Fraction as a Surrogate of Reticulated Platelets Predicts the Response to Corticosteroids in Adults with Immune Thrombocytopenia

“…Patients with primary immune thrombocytopenia (ITP) who exhibit severe thrombocytopenia and/or significant bleeding require treatment with corticosteroids and/or intravenous immunoglobulin (IVIG) as first-line therapy [1, 2]. Predicting the response to corticosteroids may help to avoid unnecessary therapy, and side effects, and facilitate the use of optional therapeutic agents.…”

Chinese expert consensus on diagnosis and treatment of coagulation dysfunction in COVID-19

“…For severe COVID-19 patients who are not bleeding, platelet transfusion is recommended if the platelet count is < 20 × 10 9 /L; for severe COVID-19 patients who intend to undergo a lumbar puncture or present with active bleeding, platelet transfusion is recommended if the platelet count is < 50 × 10 9 /L; for severe COVID-19 patients undergoing ECMO, platelet transfusion is recommended if the platelet count is < 80 × 10 9 /L [30,37]. Previous studies have shown that the use of platelet count as an indication for platelet transfusions has not been shown to improve the outcomes of critically ill patients [38]. However, the use of platelet function indicators to guide platelet transfusions in critically ill patients with thrombocytopenia may be beneficial for improving the outcome of these patients [39].…”