title: Guidance on platelet transfusion for patients with hypoproliferative thrombocytopenia.
abstract: Patients with hypoproliferative thrombocytopenia are at an increased risk for hemorrhage and alloimmunization to platelets. Updated guidance for optimizing platelet transfusion therapy is needed as data from recent pivotal trials have the potential to change practice. This guideline, developed by a large international panel using a systematic search strategy and standardized methods to develop recommendations, incorporates recent trials not available when previous guidelines were developed. We found that prophylactic platelet transfusion for platelet counts less than or equal to 10 × 10(9)/L is the optimal approach to decrease the risk of hemorrhage for patients requiring chemotherapy or undergoing allogeneic or autologous transplantation. A low dose of platelets (1.41 × 10(11)/m2) is hemostatically as effective as higher dose of platelets but requires more frequent platelet transfusions suggesting that low-dose platelets may be used in hospitalized patients. For outpatients, a median dose (2.4 × 10(11)/m2) may be more cost-effective to prevent clinic visits only to receive a transfusion. In terms of platelet products, whole blood-derived platelet concentrates can be used interchangeably with apheresis platelets, and ABO-compatible platelet should be given to improve platelet increments and decrease the rate of refractoriness to platelet transfusion. For RhD-negative female children or women of child-bearing potential who have received RhD-positive platelets, Rh immunoglobulin should probably be given to prevent immunization to the RhD antigen. Providing platelet support for the alloimmunized refractory patients with ABO-matched and HLA-selected or crossmatched products is of some benefit, yet the degree of benefit needs to be assessed in the era of leukoreduction.
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Health Services, Edmonton, Canada. Electronic address: Susan.Nahirniak@albertahealthservices.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Nahirniak
authors.affiliation: Puget Sound Blood Centre and University of Washington School of Medicine, Seattle, WA.
authors.forename: Sherrill J
authors.initials: SJ
authors.lastname: Slichter
authors.affiliation: Canadian Blood Services, Toronto, Canada.
authors.forename: Susano
authors.initials: S
authors.lastname: Tanael
authors.affiliation: Centre of Transfusion Medicine, Cellular Therapy and Cryobiology, Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rebulla
authors.affiliation: Department of Laboratory Medicine, St Michael's Hospital, Department of Laboratory Medicine and Pathobiology, and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Katerina
authors.initials: K
authors.lastname: Pavenski
authors.affiliation: American Red Cross Blood Services, Penn-Jersey Region, Philadelphia, PA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Vassallo
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont and Fletcher Allen Health Care, Burlington, VT.
authors.forename: Mark
authors.initials: M
authors.lastname: Fung
authors.affiliation: Department of Pathology, University of Pittsburgh Medical Centre, Pittsburgh, PA.
authors.forename: Rene
authors.initials: R
authors.lastname: Duquesnoy
authors.affiliation: HLA Laboratory, Hematology Division, McGill University Health Centre, Montreal, Canada.
authors.forename: Chee-Loong
authors.initials: CL
authors.lastname: Saw
authors.affiliation: National Health Service Blood and Transplant, Oxford University Hospitals Trust, Oxford, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Stanworth
authors.affiliation: Department of Medicine, Ottawa Hospital and University of Ottawa, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.affiliation: Département de Pédiatrie, Universtié de Montréal, CHU Sainte-Justine Montréal, Montreal, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Hume
authors.affiliation: Department of Pathology, University of Manitoba, Winnipeg, Canada.
authors.forename: Arjuna
authors.initials: A
authors.lastname: Ponnampalam
authors.affiliation: Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Moltzan
authors.affiliation: Division of Medical Sciences, University of Victoria, Victoria, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Berry
authors.affiliation: Departments of Medicine and Obstetric Medicine, Mount Sinai Hospital, Toronto, Canada.
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
mesh_terms: D006801:Humans; D017410:Practice Guidelines as Topic; D064826:Transfusion Medicine / Q000592:standards*
keywords: Hypoproliferative thrombocytopenia; Platelet products; Platelet transfusion