Extended Small-Dose Platelet Transfusions in Multitransfused Hemato-Oncological Patients: A Single-Center Experience

Abstract

Background: Refractoriness to platelet transfusion, prevalent among 15-20% of hemato-oncological patients, is associated with multitransfusions and inferior outcomes. We evaluated the effectiveness of extended slow-dose transfusion (ESDT) in increasing platelet increments in multitransfused patients. Methods: Patients treated after the implementation of ESDT were compared with historical controls treated with standard single-donor platelet (SDP) transfusions. Cohorts of early and late recipients were assembled for comparison, i.e. the 8th or 9th and 11th platelet unit per patient, respectively. Patients in the ESDT group received transfusions equal to half an SDP unit, administered over 4 h. Effectiveness was defined as a higher corrected count increment (CCI) at 1, 12, and 24 h after transfusion. Results: In the early-recipients cohort, 24-h-posttransfusion increments were available for 29 ESDT patients and 6 standard patients, and did not differ significantly between the groups (p = 0.078). The 24-h-posttransfusion increment was available for 20 ESDT patients and 7 standard patients in the late-recipients cohort. The CCI was significantly higher in the ESDT group (p = 0.042). ABO compatibility improved the CCI (p = 0.01). Conclusions: ESDT demonstrated slightly higher increments at 24 h after transfusion in late recipients, suggesting this could be a cost-effective approach for the treatment of thrombocytopenic multitransfused hemato-oncological patients.

Extent of transfusion support in a developing country in managing a bleeding acute myeloid leukemia patient with platelet transfusion refractoriness

“…[ 2 ] In Tzadok et al . and extended small dose platelet transfusion group, patients received a continuous 24 h SDP transfusion with each dose comprising 1.5 × 10 11 platelets given over 4 to 6 h.[ 3 6 ] In the present patient, double dose SDP was divided into six aliquots with 1 × 10 11 platelets in each aliquot transfused over 4 h in closed system.…”

“…[ 2 ] PTR is a serious and common complication observed in 15%–25% of patients receiving treatment for leukemia. [ 2 3 ]…”

“…When patients with PTR have no HLA/HPA-compatible platelet donors or in the setting of ongoing bleeding, massive platelet transfusion, and continuous platelet transfusion commonly known as “platelet drips” were attempted with varied results. [ 2 3 6 ]…”

“…There are few reports in the literature about continuous platelet transfusion as an alternative method for managing bleeding in PTR. [ 2 3 6 ] Here, we discuss one such case of AML with extramedullary involvement presenting with active bleeding with PTR managed using continuous platelet transfusion.…”