Clinical factors influencing the efficacy of pooled platelet transfusions

Abstract

To determine the relative importance of clinical factors on the efficacy of platelet transfusions, 941 pooled platelet transfusions from HLA-unmatched donors were studied prospectively in 133 patients with bone marrow failure. Multiple linear regression analyses identified the major factors influencing one-hour-corrected increments (CI) as prior splenectomy, bone marrow transplantation, disseminated intravascular coagulation, concurrent intravenous amphotericin B, splenomegaly, and HLA antibody grade. The relative impact of these factors on CI has been quantitated by using a formula developed from these data. A linear relationship was demonstrated between increasing percentage of HLA antibody grade and decreasing CI. A number of other factors were less important in the linear regression model than the aforementioned major factors. These included platelet-specific antibodies, concurrent antibacterial antibiotics, clinical bleeding grade, and temperature. Factors that did not influence CI included the number of prior platelet transfusions, prior granulocyte transfusions, prior red cell transfusions, infection, age, blood group, diagnosis, sex, pretransfusion platelet count, prior pregnancies, and concurrent antineoplastic drugs. This study identified major clinical factors that significantly influenced CI and were major causes of refractoriness to pooled platelet transfusions.

Selecting donors of platelets for refractory patientson the basis of HLA antibody specificity

“…Time from transfusion to posttransfusion platelet count 02. PRA level (0, 1-10%, 10-80%, or 80-100%) 03. Fever (temperature >38.5°C during the 6 hours before or after transfusion) 04.…”

Transfusing platelets 2 h after the completion of amphotericin‐B decreases its detrimental effect on transfused platelet recovery and survival

“…With the increased use of high-dose chemotherapy and the absence of a clinically reliable megakaryocytic growth factor, platelet transfusion continues to be the standard support for amegakaryocytic thrombocytopenia (Bishop et al, 1988). Patients receiving myeloablative therapy will possibly require amphotericin-B prophylaxis and/or therapy, as well as platelet transfusion support (Terrell & Hughes, 1992;Riley et al, 1994).…”

“…Often both supportive care modalities are used together (Heyman et al, 1990). Bishop et al (1988) have demonstrated, in a retrospective study, that the presence of amphotericin-B in the medical regimen of transfused patients negatively influences platelet recovery. Their study does not address the timing of administering both therapies, however.…”

“…Myelosuppressed patients requiring platelet transfusion support have frequent and complex medical problems that influence the recovery and survival of transfused platelets. Infections, splenomegaly, concurrent intravenous administration of drugs, bone marrow transplantation and specific complications of bone marrow transplantation such as graft vs. host disease (GVH) and veno-occlusive disease (VOD) are known to influence the efficacy of transfused platelets (Bishop et al, 1988;Hussein et al, 1990;Norol et al, 1994).…”

“…Sloand et al (1994) demonstrated in an in-vitro study that the extent of amphotericin-B's detrimental effect on platelet membrane glycoprotein depends on the number of days platelets have been in storage as well as the concentration and length of time platelets are exposed to the antimicrobial agent. In a study by Bishop et al (1988) multiple linear regression analysis identified concurrent administration of intravenous amphotericin-B as one of the major factors influencing platelet recovery. Kulpa et al (1981) evaluated the results of platelet transfusions to four acute leukaemia patients before, during and after amphotericin-B therapy.…”