Consensus and controversies in platelet transfusion: trigger for indication, and platelet dose.
Platelet transfusion is about to commemorate its 50th year since its introduction in therapeutics. It is then surprising to see, that in spite of reaching this respectful age, we have not been able to definitely establish all the aspects related to its clinical use. Some of these facets are platelet transfusion threshold and the platelet dose to administer. Historically, two different transfusion triggers have been used for prophylactic and therapeutic platelet transfusions. For prophylactic platelet transfusion an increasing body of evidences suggests that a transfusion trigger of 10 x 10(9) per liter is appropriate for most clinical settings. In contrast, evidence for supporting a certain therapeutic transfusion trigger is lacking. Nevertheless, there is consensus that the platelet count should not be allowed to fall below 50 x 10(9) per liter in patients with acute bleeding. Another important aspect still pending of clear definition is the issue of the platelet dose to be transfused. It has been addressed by some small studies but a definite answer to this important clinical issue is, at least so far, still pending. The results of two ongoing trials, one sponsored by NIH through the Clinical Trials Network in Transfusion Medicine and Hemostasis and the other promoted by the BEST Collaborative Group are expected to help us to clearly defining the more effective and efficient way to transfuse platelet concentrates.
Lozano
M
M
Department Hemotherapy and Hemostasis, Hospital Clínic Provincial, IDIBAPS, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. mlozano@clinic.ub.es
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D032921:Consensus; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D017713:Platelet Transfusion / Q000379:methods / Q000592:standards