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Transfusion

  • Takaaki HatoEmail author
Chapter

Abstract

The efficacy of platelet transfusion in the management of ITP remains obscure. In patients with hematologic disorders undergoing myelosuppressive chemotherapy or hematopoietic stem cell transplantation, platelets are widely transfused prophylactically, and a platelet transfusion threshold of 10,000/μL has been recommended to be safe and effective. In ITP, however, prophylactic platelet transfusion is not recommended because the rise in platelet counts following platelet transfusion is not seen because of rapid destruction of transfused platelets. In ITP patients with severe active bleeding, anecdotal evidence suggests successful treatment of platelet transfusion alone or in combination with intravenous immunoglobulin. Platelet transfusion may be also considered before splenectomy in ITP patients. Recent studies suggest that laparoscopic splenectomy can be a safe and feasible procedure in ITP patients with platelet count less than 10 × 103/μL without platelet transfusion.

Keywords

Platelet Count Acute Myeloid Leukemia Hematopoietic Stem Cell Transplantation Bleeding Risk Platelet Transfusion 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Slichter SJ. Controversies in platelet transfusion therapy. Annu Rev Med. 1980;31:509–40.CrossRefPubMedGoogle Scholar
  2. 2.
    Nachman RL, Rafii S. Platelets, petechiae, and preservation of the vascular wall. N Engl J Med. 2008;359:1261–70.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hanson SR, Slichter SJ. Platelet kinetics in patients with bone marrow hypoplasia: evidence for a fixed platelet requirement. Blood. 1985;66:1105–9.PubMedGoogle Scholar
  4. 4.
    Morowski M, Vogtle T, Kraft P, et al. Only severe thrombocytopenia results in bleeding and defective thrombus formation in mice. Blood. 2013;121:4938–47.CrossRefPubMedGoogle Scholar
  5. 5.
    Slichter SJ, Harker LA. Thrombocytopenia: mechanisms and management of defects in platelet production. Clin Haematol. 1978;7:523–39.PubMedGoogle Scholar
  6. 6.
    Slichter SJ, Kaufman RM, Assmann SF, et al. Dose of prophylactic platelet transfusions and prevention of hemorrhage. N Engl J Med. 2010;362:600–13.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Diedrich B, Remberger M, Shanwell A, et al. A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 × 10(9) per L versus 30 × 10(9) per L in allogeneic hematopoietic progenitor cell transplant recipients. Transfusion. 2005;45:1064–72.Google Scholar
  8. 8.
    Heckman KD, Weiner GJ, Davis CS, et al. Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/μL versus 20,000/μL. J Clin Oncol. 1997;15:1143–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Rebulla P, Finazzi G, Marangoni F, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. N Engl J Med. 1997;337:1870–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Zumberg MS, del Rosario ML, Nejame CF, et al. A prospective randomized trial of prophylactic platelet transfusion and bleeding incidence in hematopoietic stem cell transplant recipients: 10,000/L versus 20,000/microL trigger. Biol Blood Marrow Transplant. 2002;8:569–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Estcourt LJ, Stanworth SJ, Murphy MF. Platelet transfusions for patients with haematological malignancies: who needs them? Br J Haematol. 2011;154:425–40.CrossRefPubMedGoogle Scholar
  12. 12.
    Estcourt LJ, Stanworth SJ, Doree C, et al. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev. 2015;11:CD010983.PubMedCentralGoogle Scholar
  13. 13.
    Webert K, Cook RJ, Sigouin CS, et al. The risk of bleeding in thrombocytopenic patients with acute myeloid leukemia. Haematologica. 2006;91:1530–7.PubMedGoogle Scholar
  14. 14.
    Gerber DE, Segal JB, Levy MY, et al. The incidence of and risk factors for venous thromboembolism (VTE) and bleeding among 1514 patients undergoing hematopoietic stem cell transplantation: implications for VTE prevention. Blood. 2008;112:504–10.CrossRefPubMedGoogle Scholar
  15. 15.
    Lawrence JB, Yomtovian RA, Hammons T, et al. Lowering the prophylactic platelet transfusion threshold: a prospective analysis. Leuk Lymphoma. 2001;41:67–76.CrossRefPubMedGoogle Scholar
  16. 16.
    Friedmann AM, Sengul H, Lehmann H, et al. Do basic laboratory tests or clinical observations predict bleeding in thrombocytopenic oncology patients? A reevaluation of prophylactic platelet transfusions. Transfus Med Rev. 2002;16:34–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Najima Y, Ohashi K, Miyazawa M, et al. Intracranial hemorrhage following allogeneic hematopoietic stem cell transplantation. Am J Hematol. 2009;84:298–301.CrossRefPubMedGoogle Scholar
  18. 18.
    Nevo S, Fuller AK, Hartley E, et al. Acute bleeding complications in patients after hematopoietic stem cell transplantation with prophylactic platelet transfusion triggers of 10 × 10(9) and 20 × 10(9) per L. Transfusion. 2007;47:801–12.Google Scholar
  19. 19.
    Goerge T, Ho-Tin-Noe B, Carbo C, et al. Inflammation induces hemorrhage in thrombocytopenia. Blood. 2008;111:4958–64.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Valeri CR, Khuri S, Ragno G. Nonsurgical bleeding diathesis in anemic thrombocytopenic patients: role of temperature, red blood cells, platelets, and plasma-clotting proteins. Transfusion. 2007;47:206S–48S.CrossRefPubMedGoogle Scholar
  21. 21.
    Eugster M, Reinhart WH. The influence of the haematocrit on primary haemostasis in vitro. Thromb Haemost. 2005;94:1213–8.Google Scholar
  22. 22.
    Turitto VT, Weiss HJ. Red blood cells: their dual role in thrombus formation. Science. 1980;207:541–3.CrossRefPubMedGoogle Scholar
  23. 23.
    Uijttewaal WS, Nijhof EJ, Bronkhorst PJ, et al. Near-wall excess of platelets induced by lateral migration of erythrocytes in flowing blood. Am J Physiol. 1993;264:H1239–44.PubMedGoogle Scholar
  24. 24.
    Wandt H, Schaefer-Eckart K, Wendelin K, et al. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet. 2012;380:1309–16.CrossRefPubMedGoogle Scholar
  25. 25.
    Stanworth SJ, Estcourt LJ, Powter G, et al. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med. 2013;368:1771–80.CrossRefPubMedGoogle Scholar
  26. 26.
    Heddle NM, Cook RJ, Tinmouth A, et al. A randomized controlled trial comparing standard- and low-dose strategies for transfusion of platelets (SToP) to patients with thrombocytopenia. Blood. 2009;113:1564–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Buchanan GR, Scher CS, Button LN, et al. Use of homologous platelet survival in differential diagnoses of chronic thrombocytopenia in childhood. Pediatrics. 1977;59:45–54.PubMedGoogle Scholar
  28. 28.
    Stoll D, Cines DB, Aster RH, et al. Platelet kinetics in patients with idiopathic thrombocytopenic purpura and moderate thrombocytopenia. Blood. 1985;65:584–8.PubMedGoogle Scholar
  29. 29.
    Carr JM, Kruskall MS, Kaye JA, et al. Efficacy of platelet transfusions in immune thrombocytopenia. Am J Med. 1986;80:1051–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Salama A, Kiesewetter H, Kalus U, et al. Massive platelet transfusion is a rapidly effective emergency treatment in patients with refractory autoimmune thrombocytopenia. Thromb Haemost. 2008;100:762–5.PubMedGoogle Scholar
  31. 31.
    Spahr JE, Rodgers GM. Treatment of immune-mediated thrombocytopenia purpura with concurrent intravenous immunoglobulin and platelet transfusion: a retrospective review of 40 patients. Am J Hematol. 2008;83:122–5.CrossRefPubMedGoogle Scholar
  32. 32.
    Danese MD, Lindquist K, Gleeson M, et al. Cost and mortality associated with hospitalizations in patients with immune thrombocytopenic purpura. Am J Hematol. 2009;84:631–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Goel R, Ness PM, Takemoto CM, et al. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood. 2015;125:1470–6.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Chen X, Peng B, Cai Y, et al. Laparoscopic splenectomy for patients with immune thrombocytopenia and very low platelet count: is platelet transfusion necessary? J Surg Res. 2011;170:e225–32.CrossRefPubMedGoogle Scholar
  35. 35.
    Wu Z, Zhou J, Li J, et al. The feasibility of laparoscopic splenectomy for ITP patients without preoperative platelet transfusion. Hepatogastroenterology. 2012;59:81–5.PubMedGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2017

Authors and Affiliations

  1. 1.Division of Blood Transfusion and Cell TherapyEhime University HospitalToonJapan

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