title: A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation.
abstract: Prophylactic platelet transfusions are considered as standard in most hematology centers, but there is a long-standing controversy as to whether standard prophylactic platelet transfusions are necessary or whether this strategy could be replaced by a therapeutic transfusion strategy. In 106 consecutive cases of patients receiving 140 autologous peripheral blood stem cell transplantations, we used a therapeutic platelet transfusion protocol when patients were in a clinically stable condition. Platelet transfusions were only used when relevant bleeding occurred (more than petechial). Median duration of thrombocytopenia <20 x 10(9)/l and <10 x 10(9)/l was 6 and 3 days, which resulted in a total of 989 and 508 days, respectively. In only 26 out of 140 transplants (19%), we observed clinically relevant bleeding of minor or moderate severity. No severe or life-threatening bleeding was registered. The median and mean number of single donor platelet transfusions was one per transplant (range 0-18). One-third of all transplants, and 47% after high-dose melphalan could be performed without any platelet transfusion. Compared with a historical control group, we could reduce the number of platelet transfusions by one half. This therapeutic platelet transfusion strategy can be performed safely resulting in a considerable reduction in prophylactic platelet transfusions.
authors.affiliation: BMT-Unit, Hematology/Oncology, Klinikum Nürnberg Nord, Nürnberg, Germany. wandt@klinikum-nuernberg.de
authors.forename: H
authors.initials: H
authors.lastname: Wandt
authors.forename: K
authors.initials: K
authors.lastname: Schaefer-Eckart
authors.forename: M
authors.initials: M
authors.lastname: Frank
authors.forename: J
authors.initials: J
authors.lastname: Birkmann
authors.forename: M
authors.initials: M
authors.lastname: Wilhelm
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001804:Blood Transfusion, Autologous; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D017713:Platelet Transfusion / Q000009:adverse effects; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy; D019172:Transplantation Conditioning / Q000379:methods / Q000706:statistics & numerical data; D014182:Transplantation, Autologous