Dose of prophylactic platelet transfusions and prevention of hemorrhage.
BACKGROUND
We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia.


METHODS
We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x10(11), 2.2x10(11), or 4.4x10(11) platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria).


RESULTS
In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25x10(11)) than in the medium-dose group (11.25x10(11)) or the high-dose group (19.63x10(11)) (P=0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001).


CONCLUSIONS
Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1x10(11) and 4.4x10(11) platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.)
Slichter
Sherrill J
SJ
Puget Sound Blood Center, Seattle, WA 98104-1256, USA. sjslichter@psbc.org.
Kaufman
Richard M
RM
Assmann
Susan F
SF
McCullough
Jeffrey
J
Triulzi
Darrell J
DJ
Strauss
Ronald G
RG
Gernsheimer
Terry B
TB
Ness
Paul M
PM
Brecher
Mark E
ME
Josephson
Cassandra D
CD
Konkle
Barbara A
BA
Woodson
Robert D
RD
Ortel
Thomas L
TL
Hillyer
Christopher D
CD
Skerrett
Donna L
DL
McCrae
Keith R
KR
Sloan
Steven R
SR
Uhl
Lynne
L
George
James N
JN
Aquino
Victor M
VM
Manno
Catherine S
CS
McFarland
Janice G
JG
Hess
John R
JR
Leissinger
Cindy
C
Granger
Suzanne
S
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000628:therapy; D010976:Platelet Count; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy*
D000970:Antineoplastic Agents