Therapeutic efficacy of platelet transfusion in patients with acute leukemia: an evaluation of methods.
BACKGROUND
Clinical effect of platelet (PLT) transfusion is monitored by measures of PLT viability (PLT recovery and survival) and functionality. In this study we evaluate and compare transfusion effect measures in patients with chemotherapy-induced thrombocytopenia due to treatment of acute leukemia.


METHODS
Forty transfusions (28 conventional gamma-irradiated and 12 pathogen-inactivated photochemical-treated PLT concentrates [PCs]) were investigated. PC quality was analyzed immediately before transfusion. Samples were collected from thrombocytopenic patients at 1 and 24 hours for PLT increments and thromboelastography (TEG) with assessments of bleeding score and intertransfusion interval (ITI). Data were analyzed by Spearman's correlation. Patient and PC variables influencing the effect of transfusion were analyzed by use of a mixed-effects model.


RESULTS
PLT dose, storage time, and pathogen inactivation correlated with PLT recovery but not with PLT survival (including ITI), TEG, or clinical bleeding. Fever was negatively correlated with PLT survival but did not affect PLT recovery. After 1 and 24 hours, strong correlations were observed within measures of PLT viability and between PLT increment and the TEG value maximal amplitude (MA). Negative correlation was observed between late MA increment and clinical bleeding status after transfusion (r = -0.494, p = 0.008). PLT count increments did not correlate to clinical bleeding status.


CONCLUSIONS
PLT dose and quality of PCs are important for optimal immediate transfusion response, whereas duration of transfusion effect is influenced mainly by patient variables. The TEG value MA correlates with PLT count increments and bleeding, thus reflecting both PLT viability and functionality.
Apelseth
Torunn O
TO
Blood Bank, the Section for Hematology, Department of Medicine, Haukeland University Hospital, Bergen, Norway. torunn.oveland.apelseth@helse-bergen.no
Bruserud
Oystein
O
Wentzel-Larsen
Tore
T
Hervig
Tor
T
D000017:ABO Blood-Group System; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001792:Blood Platelets / Q000166:cytology / Q000502:physiology; D001830:Body Surface Area; D002245:Carbon Dioxide / Q000097:blood; D002470:Cell Survival; D004282:Documentation; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006785:Hospitals, University; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000188:drug therapy*; D008297:Male; D009664:Norway; D010100:Oxygen / Q000097:blood; D010976:Platelet Count; D017713:Platelet Transfusion / Q000379:methods*; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*
D000017:ABO Blood-Group System; D000970:Antineoplastic Agents; D002245:Carbon Dioxide; D010100:Oxygen