title: Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit.
abstract: BACKGROUND
  Thrombocytopenia is a frequent finding in critically ill cancer patients for whom indications of platelet transfusions are unclear. We herein addressed the current practices in platelet transfusion and the risk of bleeding in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit (ICU).
  
  
  METHODS
  A retrospective monocenter study over a 7-year period was conducted in a medical ICU. Adult patients with malignancies and hypoproliferative thrombocytopenia, and who received at least one platelet concentrate during their ICU stay, were included.
  
  
  RESULTS
  296 patients were included and received a total of 904 platelet transfusions, for prophylactic indications in 300 (33.2 %) episodes, for securing an invasive procedure in 257 (28.4 %), and for treatment of minor to major bleeding manifestations in 347 (38.4 %). Most prophylactic transfusions (80 %) were performed at platelet count thresholds below 10-20 × 10(9)/L. Platelet increments were generally low in all three indications, 10 (interquartile range 2-25), 11 (2-25), and 8 (0-21) × 10(9)/L, respectively. A total of 97 major ICU-acquired bleeding events occurred in 40 patients. About half of those bleeding episodes (54.7 %) occurred at platelet counts below 20 × 10(9)/L. However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding. The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).
  
  
  CONCLUSIONS
  Most prophylactic platelet transfusions were given using thresholds of 10-20 × 10(9)/L in critically ill thrombocytopenic cancer patients. The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. bassem.habr@gmail.com.
authors.forename: Bassem
authors.initials: B
authors.lastname: Habr
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. julien.charpentier@cch.aphp.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. benoit.champigneulle@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. benoit.champigneulle@cch.aphp.fr.
authors.forename: Benoît
authors.initials: B
authors.lastname: Champigneulle
authors.affiliation: Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. agnes.dechartres@htd.aphp.fr.|Centre d'épidémiologie et de recherche clinique, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France. agnes.dechartres@htd.aphp.fr.
authors.forename: Agnès
authors.initials: A
authors.lastname: Dechartres
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. daviaudfabrice@gmail.com.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. daviaudfabrice@gmail.com.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Daviaud
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. guillaume.geri@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. guillaume.geri@cch.aphp.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. alain.cariou@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. alain.cariou@cch.aphp.fr.
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. jean-daniel.chiche@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. jean-daniel.chiche@cch.aphp.fr.|Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. jean-daniel.chiche@cch.aphp.fr.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. jean-paul.mira@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. jean-paul.mira@cch.aphp.fr.|Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. jean-paul.mira@cch.aphp.fr.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. frederic.pene@cch.aphp.fr.|Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. frederic.pene@cch.aphp.fr.|Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. frederic.pene@cch.aphp.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
keywords: Bleeding; Cancer; Intensive care unit; Thrombocytopenia; Transfusion