Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia

Nahirniak, Susan; Slichter, Sherrill J.; Tanael, Susano; Rebulla, Paolo; Pavenski, Katerina; Vassallo, Ralph R.; Fung, Mark; Duquesnoy, René J.; Saw, Chee-Loong; Stanworth, Simon; Tinmouth, Alan; Hume, Heather; Ponnampalam, Arjuna; Moltzan, Catherine; Berry, Brian; Shehata, Nadine

doi:10.1016/j.tmrv.2014.11.004

Cited by 82 publications

(89 citation statements)

References 91 publications

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“…Most platelet transfusions appeared to be justified. The median platelet count was 10,900 cells/µL, which was within the recently published platelet transfusion guidelines . Because only 22% of study participants during each transfusion episode had some form of bleeding, it appears that the majority of platelet transfusions were prophylactic.…”

Section: Discussionmentioning

confidence: 69%

Platelet transfusion therapy in sub‐Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

et al. 2016

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Background Little data are available on bacterial contamination (BC) of platelet units or acute transfusion reactions to platelet transfusions (PT) in sub-Saharan Africa (SSA). Methods This prospective observational study evaluated the rate of BC of whole blood derived platelet units (WB-PU), the utility of performing Gram stains (GS) to prevent septic reactions, characteristics of patients receiving PT and the rate of acute reactions associated with PT at the Uganda Cancer Institute in Kampala, Uganda. An aliquot of each WB-PU studied was taken to perform GS and culture using the Bactec™ 9120 instrument. Study participants were monitored for reactions. Results 337 WB-PU were evaluated for BC, of which 323 units were transfused in 151 transfusion episodes to 50 patients. The frequency of BC ranged from 0.3%–2.1% (according to criteria used to define BC). The GS had high specificity (99.1%), but low sensitivity to detect units with BC. The median platelet count prior to PT was 10,900 (IQR 6,000–18,900) cells/μL. 78% of PT were given to patients with no bleeding. Acute reactions occurred in 11 transfusion episodes, involving 13 WB-PU, for a rate of 7.3% (95%CI=3.7–12.7%) per transfusion episode. All recipients of units with positive bacterial cultures were receiving antibiotics at the time of transfusion; none experienced a reaction. Conclusions The rate of BC observed in this study is lower than previously reported in SSA, but still remains a safety issue. As GS appears to be an ineffective screening tool, alternate methods should be explored to prevent transfusing bacterially-contaminated platelets in SSA.

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Section: Discussionmentioning

confidence: 69%

Platelet transfusion therapy in sub‐Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

et al. 2016

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“…A search of published literature was undertaken using the evidence from several systematic reviews that are either currently being undertaken by members of the writing group (Estcourt et al , ,b,c), or that have been recently published (Hedges et al , ; van Veen et al , ; Lieberman et al , ; Pavenski et al , ; Wardrop et al , ; Kumar et al , ; Vassallo et al , ; Crighton et al , ; Nahirniak et al , ). This was supplemented by searching PubMed and the United Kingdom Blood Transfusion Services (UKBTS)/Systematic Review Initiative (SRI) Transfusion Evidence Library (http://www.transfusionevidencelibrary.com) up to November 2014 using specific search terms relevant to each section of the guidelines.…”

Section: Scopementioning

confidence: 99%

Guidelines for the use of platelet transfusions

et al. 2016

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“…Alternative strategies do exist for bleeding patients like Emma, including the use of random platelets, local hemorrhage control, and so on. The preemptive use of HLA platelets as a prophylactic against alloimmunization should not be attempted; it creates an undue burden on the population and causes a delay in platelet delivery and associated symptom relief [12,13].…”

Section: Ethically and Clinically Relevant Considerations For Platelementioning

confidence: 99%

Ethical Questions about Platelet Transfusions at the End of Life

Sherbeck

Boss

2016

AMA Journal of Ethics

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This case of platelet transfusion in palliative care illustrates a common dilemma in transfusion medicine: approval of the use of a scarce, yet potentially life-saving, resource. As in this case, these decisions often involve seriously ill patients with acute needs and evolving goals of care. The use of resources to treat the patient at hand must be balanced against maintaining adequate resources to treat future patients. In this setting, the ethical principles of beneficence and social justice are in conflict. CaseDr. J, a second-year resident on the palliative care service, has become quite close to his patient, Emma, a 5-year-old girl with acute lymphoblastic leukemia. Two years ago, Emma completed successful chemotherapy and achieved remission, but a recent bone marrow biopsy showed lymphoblastic infiltration. She was started on a rescue therapy program with little response and underwent a bone marrow transplant. During this relapse, she has been hospitalized on multiple occasions for infections and bleeding, which required blood and platelet transfusions, and is now receiving palliative care for tumor lysis syndrome. It is Emma's medical team's opinion that there is no more that can be done to cure her leukemia, which prompted her transfer to the palliative care service. Shortly after transfer, Emma developed bright red blood per rectum, and Dr. J requested human leukocyte antigen (HLA)-matched platelet transfusion for her to help stop the bleeding.Dr. S, a third-year pathology resident, received Dr. J's request for HLA-matched platelets. Typically, pathologists oversee platelet distribution, since they are the physicians responsible for administering transfusion services in a hospital-maintaining an adequate blood supply, monitoring blood donor and patient-recipient safety, ensuring appropriate blood utilization, and directing the preparation and safe use of blood components according to a hospital's platelet distribution protocol. Since Dr. S oversees a busy transfusion service with many sick patients requiring blood and platelets, one of her duties is to carefully assess each request for these limited resources. She contacts Dr. J and asks for more information about his request. Dr. S explains that HLA-matched

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Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia

Cited by 82 publications

References 91 publications

Platelet transfusion therapy in sub‐Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

Platelet transfusion therapy in sub‐Saharan Africa: bacterial contamination, recipient characteristics, and acute transfusion reactions

Guidelines for the use of platelet transfusions

Ethical Questions about Platelet Transfusions at the End of Life

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