How I use platelet transfusions

Stanworth, Simon J; Shah, Akshay

doi:10.1182/blood.2022016558

Cited by 16 publications

(12 citation statements)

References 117 publications

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“…[124] One prospective study found no significant improvement in TGT and ROTEM after platelet transfusions, indicating no change in the global hemostatic potential. [122] Furthermore, platelets are the blood component most commonly associated with transfusion reactions, [125] such as fever, alloimmunization, thrombosis, and acute lung injury. [126][127][128] Febrile non-hemolytic transfusion reactions and allergic reactions may occur at a reported frequency of 1 in 14 and 1 in 50 per transfusion unit, respectively.…”

Section: Interventions To Improve Platelet Count In Patients With Cir...mentioning

confidence: 99%

The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review

et al. 2023

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Patients with cirrhosis develop complex alterations in primary hemostasis that include both hypocoagulable and hypercoagulable features. This includes thrombocytopenia, multiple alterations of platelet function, and increased plasma levels of von Willebrand factor. Contrary to the historical view that platelet dysfunction in cirrhosis might be responsible for an increased bleeding tendency, the current theory posits a rebalanced hemostasis in patients with cirrhosis. Severe thrombocytopenia is not indicative of the bleeding risk in patients undergoing invasive procedures and does not dictate per se the need for pre-procedural prophylaxis. A more comprehensive and individualized risk assessment should combine hemostatic impairment, the severity of decompensation and systemic inflammation, and the presence of additional factors that may impair platelet function, such as acute kidney injury and bacterial infections. Although there are multiple, complex alterations of platelet function in cirrhosis, their net effect is not yet fully understood. More investigations evaluating the association between alterations of platelet function and bleeding/thrombosis may improve risk stratification in patients with decompensated cirrhosis. Besides hemostasis, the assessment of von Willebrand factor Ag and ADP-induced, whole-blood platelet aggregation normalized by platelet count (VITRO score and PLT ratio) are promising biomarkers to predict the risk of hepatic decompensation and survival in both compensated and decompensated patients. Further investigations into the in vivo interplay between platelets, circulating blood elements, and endothelial cells may help advance our understanding of cirrhotic coagulopathy. Here, we review the complex changes in platelets and primary hemostasis in cirrhosis and their potential clinical implications.

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Section: Interventions To Improve Platelet Count In Patients With Cir...mentioning

confidence: 99%

The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review

et al. 2023

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“…1 ). 30 In neonates, it has been shown that liberal transfusion of PCs increases the risk of hemorrhage and mortality. 31 32 Using PCs bears an inherent risk of alloimmunization, transfusion-transmitted infections, and allergic reactions.…”

Section: Current Treatment Optionsmentioning

confidence: 99%

Treatment of Inherited Platelet Disorders: Current Status and Future Options

Bargehr,

Knöfler,

Streif

2023

Hamostaseologie

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Inherited platelet disorders (IPDs) comprise a heterogeneous group of entities that manifest with variable bleeding tendencies. For successful treatment, the underlying platelet disorder, bleeding severity and location, age, and sex must be considered in the broader clinical context. Previous information from the AWMF S2K guideline #086–004 (www.awmf.org) is evaluated for validity and supplemented by information of new available and future treatment options and clinical scenarios that need specific measures. Special attention is given to the treatment of menorrhagia and risk management during pregnancy in women with IPDs. Established treatment options of IPDs include local hemostatic treatment, tranexamic acid, desmopressin, platelet concentrates, and recombinant activated factor VII. Hematopoietic stem cell therapy is a curative approach for selected patients. We also provide an outlook on promising new therapies. These include autologous hematopoietic stem cell gene therapy, artificial platelets and nanoparticles, and various other procoagulant treatments that are currently tested in clinical trials in the context of hemophilia.

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“…Whether new technologies based on matching genotyped blood donors and recipients, rather than the traditional labour‐intensive serological approaches, have a role in addressing and minimising risks of alloimmunisation remains unknown and is the focus of ongoing research (Haem‐Match) 29 . Another concern is the challenge in providing ABO compatible platelet transfusions 30 . There are opportunities to improve patient outcomes by expanding both the diversity of the donor pool and the methods by which we match blood transfusions.…”

Section: Recent Blood Shortages Highlight the Need To Reduce Unnecess...mentioning

confidence: 99%

Harnessing the potential of data‐driven strategies to optimise transfusion practice

Evans,

Murphy,

Foy

et al. 2023

Br J Haematol

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SummaryNo one doubts the significant variation in the practice of transfusion medicine. Common examples are the variability in transfusion thresholds and the use of tranexamic acid for surgery with likely high blood loss despite evidence‐based standards. There is a long history of applying different strategies to address this variation, including education, clinical guidelines, audit and feedback, but the effectiveness and cost‐effectiveness of these initiatives remains unclear. Advances in computerised decision support systems and the application of novel electronic capabilities offer alternative approaches to improving transfusion practice. In England, the National Institute for Health and Care Research funded a Blood and Transplant Research Unit (BTRU) programme focussing on ‘A data‐enabled programme of research to improve transfusion practices’. The overarching aim of the BTRU is to accelerate the development of data‐driven methods to optimise the use of blood and transfusion alternatives, and to integrate them within routine practice to improve patient outcomes. One particular area of focus is implementation science to address variation in practice.

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How I use platelet transfusions

Cited by 16 publications

References 117 publications

The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review

The evolving knowledge on primary hemostasis in patients with cirrhosis: A comprehensive review

Treatment of Inherited Platelet Disorders: Current Status and Future Options

Harnessing the potential of data‐driven strategies to optimise transfusion practice

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