Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylatic, platelet transfusions

Friedmann, Alison M.; Şengül, Haydar; Lehmann, Harold P.; Schwartz, Cindy L.; Goodman, Steven

doi:10.1053/tmrv.2002.29403

Cited by 135 publications

(105 citation statements)

References 30 publications

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“…Additionally, a significant association was found between previous HSCT and bleeding when the skin-only bleeds were removed, in line with the findings of Freidmann et al, whose analysis included only WHO grade 3 and 4 bleeding. 4 With the limited resources available, data on fever were only collected on a large but not full subset of in-patients involved in the TOPPS trial. For the TOPPS trial as a whole, data completeness, including that for the main bleeding outcomes, was very high and sensitivity analyses found that the analysis subsets were similar to the main dataset.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study. Freidmann et al 4 identified clinical characteristics such as previous transplantation as more significant determinants of bleeding risk than platelet count. A retrospective analysis of a much earlier platelet threshold trial 5,6 suggested that occurrence of lower grades of bleeding might predict higher grades of bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

et al. 2015

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This study is a further analysis of the TOPPS trial data and assesses patients' baseline characteristics at enrolment, burden of thrombocytopenia, presence of fever and presence of minor hemorrhage as potential risk factors for WHO grade 2 to 4 bleeding. Recurrent event analyses have been used to allow assessment of bleeding over the 30-day trial period and to account for multiple bleeds per patient. MethodsDetails of the UK and Australian TOPPS randomized trial have been published previously .2,8,10 Six hundred patients were randomized to receive either prophylactic platelet transfusions if the platelet count was <10x10 9 /L (n=299), or no prophylaxis (n=301). The trial was approved by independent ethics committees. Although the median number of days with complete data was 30, bleeding data were not complete for all 30 days for all patients. The vast majority of bleeds were inpatient bleeds 8 and, as incomplete records often related to when the patient was at home, no bleeding was assumed on days for which no data were reported.Bleeding types were grouped to describe characteristics of bleeding: skin bruising included petechiae, purpura, and bruising; gastrointestinal bleeding included blood in the stool, melena and hematemesis; mouth bleeding included oral blood blisters and oropharyngeal bleeding; and other included musculoskeletal or deep tissue bleeding, eyes and visual impairment, pleural tap, and cerebral bleeds.For the modeling (Figure 1), patients were grouped by treatment plan [autologous hematopoietic stem cell transplant (HSCT) and chemotherapy (induction and consolidation)/allogeneic HSCT (myeloablative and reduced intensity)] and diagnosis [acute myeloid leukemia (AML), myeloma, lymphoma and other diagnoses]. In contrast to the TOPPS analysis, only the first day of consecutive bruising or petechiae was counted as a bleed, unless bleeding on the subsequent day was worse. Modeling analysisNegative binomial regression 11 was used to model baseline characteristics associated with the number of days of grade 2-4 bleeding (analysis 1). The risk factors considered are shown in Table 1. Previous HSCT (defined as any prior transplant) and relapsed disease were also considered.Recurrent event analysis 12 was used to model the hazard of a grade 2-4 bleed on any one day, accounting for previous bleeds (analyses 2a, 2b and 2c). Robust sandwich variance estimates 12 were used for the hazard confidence intervals. Analysis 2a was the main recurrent event analysis. Analysis 2b was performed on a subset of bleeding records in which the platelet count from all 3 previous days was reported. Analysis 2c was a further subset analysis in which patients' temperature from all 3 previous days Risk factors for bleeding and platelet transfusion haematologica | 2015; 100(6) 741 Figure 1. Shows the number of patients (Np) and number of bleeding records (Nr) included in each part of the analysis.Eight of the 600 patients in the TOPPS trial dataset were not included in the analyses described in this paper: two patients w...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

et al. 2015

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“…Blood pumped from one vein passes through a blood-cell separator centrifugation system with removal of the logistic regression analysis, showed no relationship between the first morning platelet count, or the lowest platelet count of the day, and the risk of hemorrhage. 16 This study identified several important patient-specific factors that appear to be associated with a greater risk for severe bleeding. These include a history of recent bleeding, uremia, a recent (less than 100 days) bone marrow transplant, and hypoalbuminemia 16 .…”

Section: Prophylactic Platelet Transfusionsmentioning

confidence: 99%

“…16 This study identified several important patient-specific factors that appear to be associated with a greater risk for severe bleeding. These include a history of recent bleeding, uremia, a recent (less than 100 days) bone marrow transplant, and hypoalbuminemia 16 .…”

Section: Prophylactic Platelet Transfusionsmentioning

confidence: 99%

“…A relatively recent publication has again raised the issue about the use of therapeutic transfusions only versus the widely used threshold-defined prophylactic platelet transfusions approach 16 In a retrospective review of almost 3000 thrombocytopenic adult patients over a 10-year period Friedman et al, by using multiple…”

Section: Therapeutic Platelet Transfusionsmentioning

confidence: 99%

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Platelet Transfusion Therapy

Karim

Hoque²,

Hoque

et al. 2017

Anwer Khan Mod Med Coll J

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Patients with severe thrombocytopenia are presumed to be at increased risk for bleeding, and consequently it has been standard practice for the past four decades to give allogeneic platelet transfusions to severely thrombocytopenic patients as supportive care. Platelet transfusions may be given either prophylactically to reduce the risk of bleeding, in the absence of clinical hemorrhage (prophylactic transfusions), or to control active bleeding when present (therapeutic transfusions). Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood, which are pooled before administration, or by apheresis from single donors. Comparative studies have shown that the post transfusion increments, hemostatic benefit, and side effects are similar with either product. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are preferred when histocompatible platelet transfusions are needed. Both preparations can be stored for up to 5 days after collection at 20°C to 24°C with good maintenance of platelet viability. It is now uncommon for patients undergoing intensive chemotherapy or bone marrow transplantation to die of hemorrhage, but it is open to debate as to what degree platelet transfusions have been responsible for this change in outcome, given the many other advances in other aspects of supportive care.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 40-46

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Prophylactic platelet transfusion for haemorrhage after chemotherapy and stem cell transplantation

Stanworth

Hyde

Heddle

et al. 2004

Cochrane Database of Systematic Reviews

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There are no reasons to change current practice but uncertainty about the practice of prophylactic transfusion therapy should be recognised, particularly in the light of concerns about the scenario that blood products, including platelets, could become an increasingly scarce resource in the future and for which adequate alternatives do not exist. Consideration should be given to developing adequately powered trials comparing strategies of prophylaxis versus therapeutic platelet transfusion.

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Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylatic, platelet transfusions

Cited by 135 publications

References 30 publications

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis

Platelet Transfusion Therapy

Prophylactic platelet transfusion for haemorrhage after chemotherapy and stem cell transplantation

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