Safety and Cost Effectiveness of a 10 × 109/L Trigger for Prophylactic Platelet Transfusions Compared With the Traditional 20 × 109/L Trigger: A Prospective Comparative Trial in 105 Patients With Acute Myeloid Leukemia

Abstract

In 105 consecutive patients with de novo acute myeloid leukemia (French-American-British M3 excluded), we compared prospectively the risk of bleeding complications, the number of platelet and red blood cell transfusions administered, and the costs of transfusions using two different prophylactic platelet transfusion protocols. Two hundred sixteen cycles of induction or consolidation chemotherapy and 3,843 days of thrombocytopenia less than 25 × 109/L were evaluated. At the start of the study, each of the 17 participating centers decided whether they would use a 10 × 109/L prophylactic platelet transfusion trigger (group A/8 centers) or a 20 × 109/L trigger (group B/9 centers). Bleeding complications (World Health Organization grade 2-4) during treatment cycles were comparable in the two groups: 20 of 110 (18%) in group A and 18 of 106 (17%) in group B (P = .8). Serious bleeding events (grade 3-4) were generally not related to the patient's platelet count but were the consequence of local lesions and plasma coagulation factor deficiencies due to sepsis. Eighty-six percent of the serious bleeding episodes occurred during induction chemotherapy. No patient died of a bleeding complication. There were no significant differences in the number of red blood cell transfusions administered between the two groups, but there were significant differences in the number of platelet transfusions administered per treatment cycle: pooled random donor platelet concentrates averaged 15.4 versus 25.4 (P < .01) and apheresis platelets averaged 3.0 versus 4.8 (P < .05) for group A versus group B, respectively. This resulted in the cost of platelet therapy being one third lower in group A compared with group B without any associated increase in bleeding risk.

Immature platelet fraction measurement: a future guide to platelet transfusion requirement after haematopoietic stem cell transplantation

“…There is a view that most prophylactic transfusions are clinically unnecessary even at a threshold of 10 × 9 L −1 (Gaydos et al ., 1962; Roy et al ., 1973), and some groups are suggesting avoiding the use of prophylactic platelets completely and the decision to administer platelets should incorporate individual clinical characteristics of the patient and not be a reflexive reaction to the platelet count (Wandt et al ., 1998; Wandt et al ., 2001). For example, in autograft patients, we can predict platelet regeneration 24–48 h after a rise in the IPF percentage.…”

Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia

“…A relationship between thrombocytopenia and an increased risk of bleeding has clearly been established and platelet (PLT) transfusions are effective in decreasing the bleeding risk and therapy‐related mortality in thrombocytopenic patients 1,2 . Recommendations for PLT transfusions are based on a variety of retrospective and prospective studies supporting a transfusion threshold of 5 × 10 9 to 10 × 10 9 /L in the absence of plasmatic coagulation abnormalities 3‐10 . Prophylactic transfusion of PLTs above this threshold is generally not recommended and the benefits of PLT transfusions must be balanced carefully against the potential risks of any transfusion.…”

A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 × 109 per L versus 30 × 109 per L in allogeneic hematopoietic progenitor cell transplant recipients

“…Traditionally, the transfusion trigger has been set at 20 × 10 9 PLTs per L on the basis of a study performed in the early 1960s, which showed that severe hemorrhages rarely occurred in patients above this limit, in spite of widespread aspirin use 13 . In recent years, a lower “safe” threshold has been used in patients with various conditions 14‐22 . Several of those authors also reported a significant reduction in the use of PLT transfusions with a lower threshold 15,16,18,19,21 .…”

“…In recent years, a lower “safe” threshold has been used in patients with various conditions 14‐22 . Several of those authors also reported a significant reduction in the use of PLT transfusions with a lower threshold 15,16,18,19,21 . Previously, only one randomized prospective study in HPCT recipients had been published.…”