title: Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 x 10(9) or 20 x 10(9) per L.
abstract: BACKGROUND
  A trigger of 10 x 10(9) per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 x 10(9) per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 x 10(9) and 20 x 10(9) per L prophylactic triggers.
  
  
  METHODS
  A total of 170 patients who received prophylactic PLT transfusions at 20 x 10(9) per L (1997-1998, SP1) and 211 patients who had prophylaxis at 10 x 10(9) per L (1999-2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT.
  
  
  RESULTS
  PLT counts less than or equal to 10 x 10(9) per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts <or=10 x 10(9)/L) was found in 19.0 percent of patients in SP2 and 7.0 percent in SP1 (p = 0.001). Patients with profound thrombocytopenia had significantly increased early mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.25-8.07) and significantly reduced overall survival (hazard ratio [HR], 1.95; 95% CI, 1.28-2.97) compared to patients with 0 to 3 PLT counts less than or equal to 10 x 10(9) per L. The association of profound thrombocytopenia with early mortality was more notable in SP2.
  
  
  CONCLUSIONS
  The 10 x 10(9) per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 x 10(9) per L trigger should be more thoroughly evaluated.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland, USA. snevo@netvision.net.il
authors.forename: Shoshan
authors.initials: S
authors.lastname: Nevo
authors.forename: Alice K
authors.initials: AK
authors.lastname: Fuller
authors.forename: Marianna L
authors.initials: ML
authors.lastname: Zahurak
authors.forename: Eric
authors.initials: E
authors.lastname: Hartley
authors.forename: Mark E
authors.initials: ME
authors.lastname: Borinsky
authors.forename: Georgia B
authors.initials: GB
authors.lastname: Vogelsang
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017713:Platelet Transfusion; D012307:Risk Factors; D015996:Survival Rate; D013921:Thrombocytopenia / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome