Clinical factors influencing posttransfusion platelet increment in patients undergoing hematopoietic progenitor cell transplantation—a prospective analysis

Ishida, Akira; Handa, Makoto; Wakui, Masatoshi; Okamoto, Shinichiro; Kamakura, Mituo; Ikeda, Yukihiro

doi:10.1046/j.1537-2995.1998.38998409004.x

Cited by 73 publications

(85 citation statements)

References 26 publications

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“…This result is disappointing but not surprising, since Bishop et al 8 demonstrated that HSCT per se was independently associated with refractoriness to platelet transfusion, and Klumpp et al 6 reported a poor response to platelet transfusion in 64% of transplanted patients. Similar results were recently obtained by Ishida et al, 4 who observed a 16- The multivariate model included all 15 variables with a P value Ͻ0.2 at the univariate analysis. For all separators, the reported P value is for a test of whether each group is different from the Autopheresis-C group.…”

Section: Discussionsupporting

confidence: 87%

“…The overall rate of alloimmunization in our patients was lower than that previously reported by Ishida et al 4 in adult subjects undergoing allogeneic or autologous HSCT (26.2%). This difference is even more evident considering de novo alloimmunization after HSCT (19.0% in the case series of Ishida).…”

Section: Leukemiacontrasting

confidence: 76%

“…1 Although leukocyte reduction and ultraviolet B irradiation have lowered the frequency of refractoriness to PC transfusion, this problem still occurs in a significant percentage of cases, especially in the clinical setting of HSCT where up to 60% of transfusions are ineffective. [2][3][4] Identification of the likely reason for refractoriness in a given individual patient should allow prevention of the problem and development of strategies capable of improving both transfusion practice and patient outcome. A number of clinical trials have evaluated the relative importance of the various causes of poor response to platelet transfusion, and several detrimental factors, both alloimmune and nonalloimmune, have been demonstrated in studies on patients with thrombocytopenia of different origin.…”

Section: Introductionmentioning

confidence: 99%

“…A number of clinical trials have evaluated the relative importance of the various causes of poor response to platelet transfusion, and several detrimental factors, both alloimmune and nonalloimmune, have been demonstrated in studies on patients with thrombocytopenia of different origin. 5 Few studies, 4,6,7 however, have been performed in the clinical setting of allogeneic HSCT, in which severe immunosuppression is induced by the conditioning regimen and the therapy for prevention of graft-versus-host disease (GVHD). Moreover, no study has specifically addressed this issue in children.…”

Section: Introductionmentioning

confidence: 99%

“…In order to gain further information in this field, we performed a prospective study, evaluating a number of clinical and immune factors which potentially affect or have been previously shown to affect the efficacy of platelet transfusion, 4,5,[8][9][10][11][12][13] in a series of 87 consecutive children who received 598 platelet transfusions after allogeneic HSCT carried out in a single institution.…”

Section: Introductionmentioning

confidence: 99%

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Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Salvaneschi

Klersy

et al. 2001

Leukemia

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Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) always require platelet transfusions, but the increase in platelet count is often less than expected. Since factors responsible for poor response to platelet transfusions in this clinical setting are largely unknown, we performed a prospective study in 87 consecutive children transplanted in a single institution. The mean 16-h corrected count increment (CCI) of 598 platelet transfusions was 5.76 ± 8.32 × 10 9 /l. Both before and after HSCT, 13.8% of patients had antibodies against HLA and/or platelet-specific antigens. Univariate analysis identified 12 factors significantly associated with a lower post-transfusion CCI, but only four reached statistical significance in the multivariate analysis. These four factors were concomitant therapy with vancomycin, alloimmunization, use of an Autopheresis cell separator for preparation of platelet concentrates and cytomegalovirus infection. We, therefore, suggest that a better response to platelet transfusions could be obtained by choosing a suitable cell separator, by avoiding the use of vancomycin and by adopting measures that reduce alloimmunization and CMV infection. Moreover, screening patients for HLA and platelet-specific antibodies before HSCT would identify the majority of subjects who will develop alloimmune refractoriness after transplantation and would allow the search for a compatible donor in advance. Leukemia (2001) 15, 1885-1891.

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Section: Discussionsupporting

confidence: 87%

Section: Leukemiacontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Salvaneschi

Klersy

et al. 2001

Leukemia

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Platelet transfusions: Utilization and associated costs in a tertiary care hospital

et al. 2000

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We implemented a prospective study to evaluate platelet transfusion utilization, resource use, and costs in a tertiary care hospital over a 6-month period. All hospitalized patients receiving platelet transfusions between July and December 1996 were followed prospectively to determine platelet use and costs. Clinical and financial data were collected, evaluated, and compared to identify trends in resource utilization based on admitting service and platelet-refractory status. One thousand nine hundred forty-four platelet units were transfused to 245 hospitalized patients (50.6% male, mean age 49 years) during the study period. The majority of platelet units transfused were single donor (N = 1,460, 75%) and administered to bone marrow patients and patients with a hematological malignancy/disorder. Median hospitalization costs per admission were $27,750, ranging from a high of $58,729 for admission to the Bone Marrow Transplant service to $13,856 per admission to the Internal Medicine/Other service. Patients were refractory to platelet transfusions during 21.6% of hospitalizations. Hospital stays were longer (35.0 days vs. 14.4 days, P < 0.001) and inpatient hospital costs ($103,956 vs. $37,817, P < 0.001) were more than two and a half times higher for patients refractory to platelet transfusions. Platelet utilization, resource use, and costs vary by admitting service. Refractoriness to platelet transfusion was associated with significantly greater costs and lengths of stay. Monitoring platelet transfusion practices, particularly for patients refractory to platelet transfusions, may be beneficial for limiting costs and improving efficacy.

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Platelet transfusion therapy

Goodnough

2001

J of Clinical Apheresis

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The relative merits of apheresis platelets and platelet concentrates are undergoing debate due to evolving issues of safety, inventory, and cost. The application of photochemical inactivation technology may eliminate any rationale for the use of apheresis platelets rather than pooled platelet concentrates, so that the relative merits of these two alternatives will be debated over costs and inventory. Doses of apheresis platelets are determined by donor platelet count and by platelet yield. The generation of a platelet apheresis inventory has been accompanied by a decline in whole blood inventory; research into the impact of these distinct donor pools on national blood policy is needed.

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Clinical factors influencing posttransfusion platelet increment in patients undergoing hematopoietic progenitor cell transplantation—a prospective analysis

Cited by 73 publications

References 26 publications

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Factors influencing post-transfusional platelet increment in pediatric patients given hematopoietic stem cell transplantation

Platelet transfusions: Utilization and associated costs in a tertiary care hospital

Platelet transfusion therapy

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