<p>Platelet Transfusion: And Update on Challenges and Outcomes</p>

Abstract

Platelet transfusion is a common practice in onco-hematologic patients for preventing or treating hemorrhages. Platelet concentrates can be transfused with therapeutic or prophylactic purposes. With the aim to help clinicians to take the decisions on platelet transfusion, some guidelines have been developed based on the current scientific evidence. However, there are some controversial issues and available scientific evidence is not enough to solve them. There is little information about what is the best platelet product to be transfused: random platelets or single donor apheresis platelets, and plasma-suspended or additive solution suspended platelets. Platelets are often transfused without respecting the ABO compatibility, but influence of this practice on platelet transfusion outcome is not well established. In the prophylactic platelet transfusion set there are some questions unsolved as the platelet threshold to transfuse prior to specific procedures or surgery, and even if platelet transfusion is necessary for some specific procedures as autologous hematopoietic stem cell transplantation. A challenging complication raised from multiple platelet transfusions is the platelet transfusion refractoriness. The study and management of this complication is often disappointing. In summary, although it is a widespread practice, platelet transfusion has still many controversial and unknown issues. The objective of this article is to review the current evidence on platelet transfusion practices, focusing on the controversial issues and challenges.

Cerebellar hemorrhage due to immune thrombocytopenia

“…La Sociedad Americana de Oncología, la Sociedad Española de Transfusión Sanguínea y la Sociedad Italiana de Medicina Transfusional e Inmunoterapia también desaconsejan la transfusión de plaquetas de manera profiláctica, sea cual sea recuento plaquetario, en pacientes que padecen de PTI (12) .…”

Biomarkers of Complement and Platelet Activation are not correlated with the One or Twenty-Four Hours Corrected Count Increments in Prophylactically Platelet Transfused Hematological Patients: a Prospective Cohort Study

“…Post-transfusion platelet response is commonly evaluated using formulas assessing the increase in PLC at defined time points after transfusion, adjusted by the estimated number of transfused platelets and individual characteristics such as body surface area (BSA). One of the most established formulas are CCI [10,20].…”

“…ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi ffi height cm ð Þ � weight kg ð Þ 3600 r In this study, platelet transfusion refractoriness was defined as a CCI < 5000 at 1 h post-transfusion [10].…”

“…Platelet concentrate characteristics, such as storage time [8], apheresis versus pooled concentrates [9] and ABO incompatibility [10] have been demonstrated to affect the post-transfusion platelet response. Additionally, platelet [11] and complement activation [12] in the platelet concentrates are suggested to potentially affect the post-transfusion response negatively.…”

Overview of Plasma and Platelet Transfusions in Critically Ill Children

“…The current prophylactic transfusion practice in the PICU is based on expert opinion, and there is a lack of objective evidence to favor prophylactic vs. therapeutic platelet transfusion. The optimum platelet count threshold for transfusion is significantly variable depending on the underlying etiology, clinical practice setting, and geographic location, which needs further evaluation (72). At present, there is a lack of evidence to replace platelet transfusions with the newer platelet substitutes, such as artificial platelets, recombinant interleukin-6 or-11, and thrombopoietin mimetics (73).…”