title: Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia.
abstract: Age-group analyses were conducted of patients in the prophylactic platelet dose trial (PLADO), which evaluated the relation between platelet dose per transfusion and bleeding. Hospitalized patients with treatment-induced hypoproliferative thrombocytopenia were randomly assigned to 1 of 3 platelet doses: 1.1 × 10(11), 2.2 × 10(11), or 4.4 × 10(11) platelets/m(2) per transfusion, given for morning counts of ≤ 10 000 platelets/μL. Daily hemostatic assessments were performed. The primary end point (percentage of patients who developed grade 2 or higher World Health Organization bleeding) was evaluated in 198 children (0-18 years) and 1044 adults. Although platelet dose did not predict bleeding for any age group, children overall had a significantly higher risk of grade 2 or higher bleeding than adults (86%, 88%, 77% vs 67% of patients aged 0-5 years, 6-12 years, 13-18 years, vs adults, respectively) and more days with grade 2 or higher bleeding (median, 3 days in each pediatric group vs 1 day in adults; P < .001). The effect of age on bleeding differed by disease treatment category and was most pronounced among autologous transplant recipients. Pediatric subjects were at higher risk of bleeding over a wide range of platelet counts, indicating that their excess bleeding risk may be because of factors other than platelet counts.
authors.affiliation: Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA.
authors.forename: Cassandra D
authors.initials: CD
authors.lastname: Josephson
authors.forename: Suzanne
authors.initials: S
authors.lastname: Granger
authors.forename: Susan F
authors.initials: SF
authors.lastname: Assmann
authors.forename: Marta-Inés
authors.initials: MI
authors.lastname: Castillejo
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Strauss
authors.forename: Sherrill J
authors.initials: SJ
authors.lastname: Slichter
authors.forename: Marie E
authors.initials: ME
authors.lastname: Steiner
authors.forename: Janna M
authors.initials: JM
authors.lastname: Journeycake
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Thornburg
authors.forename: James
authors.initials: J
authors.lastname: Bussel
authors.forename: Eric F
authors.initials: EF
authors.lastname: Grabowski
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.forename: William
authors.initials: W
authors.lastname: Savage
authors.forename: Steven R
authors.initials: SR
authors.lastname: Sloan
mesh_terms: D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D010976:Platelet Count; D017713:Platelet Transfusion / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*; D055815:Young Adult