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A Prospective Randomized Trial of Prophylactic Platelet Transfusion and Bleeding Incidence in Hematopoietic Stem Cell Transplant (HSCT) Recipients: 10, 000 μL vs. 20,000 μL Threshold

Diana Stripp, MD

University of Pennsylvania Cancer
Last Modified: May 12, 2001

Presenter: M.S. Zumberg
Affiliation: University of Florida College of Medicine

Background:

1. Threshold of Prophylactic Platelet Transfusion (PPT) for HSCT has yet to be determined
2. One retrospective review in bone marrow transplant patients showed no difference in the incidence of major bleeding episodes in pts that received PPT at 10,000 μL as compared to the conventional 20,000

   µL

   threshold. Gil-Fillman, BMT 1996;18:931-935

Materials and Methods:

1. 159 HSCT recipients, July 1997 to Dec 1999, were randomized to received a PPT when the morning platelet count fell below either 10, 000µL (10K group) or 20,000 µL (20K group).
2. A predetermined algorithm was used for additional PPT based on post-transfusion values.
3. Leukocyte reduced, single doner and ABO compatible pheresis products were used when available.
4. Definitions:
   • Major bleeding (BL) episodes: gross hematuria, any BL requiring RBC transfusion, retinal BL with visual impairment, or cerebral BL.
   • Minor BL episodes: petechial, mucosal, gastrointestinal, or genitourinary sources not requiring RBC transfusion.

Results:

1. There were no significant differences between the 2 arms in patient charateristics.
2. Mean number of total PLT transfusions (10.4 vs. 10.2, p=0.95) was similar between the 2 groups
3. No significant differences in either the number of prophylactic or therapeutic PLT transfusions between the 2 arms.
4. There were no significant differences in the cumulative incidence of BL episodes (minor 63 vs. 65, major 11 vs 14, p= 0.7)
5. There were no significant differences in mean number of days with any BL, number of RBC units transfused and number of hospital days.
6. In multivairate analyses, only the usage of amphotericine B are predictive of Plt transfusion
7. More transfusion given about the threshold in response to minor bleeds or potential for bleed in the 10k group (4.27/pt vs.1.89/pt, p=0.05).
8. Trend toward more amphotericine B usage in the 10k group (23% vs. 15%)
9. Routine pm plt count when am plt 10-15k which was responsible for 11% of the transfusion in the 10k group.

Authors' Conclusions

1. There was no excess BL when a 10K threshold for PPT was used in patients undergoing HSCT compared to a 20K trigger.
2. No decreased utilization of plt resource in the 10k group, therefore, either thresholds are reasonable for PPT guideline

Clinical/Scientific Implications:

One needs to balance between the cost of increasing monitoring (ie. pm PLT count) and staffing usage vs. the cost benefit of lowering PPT threshold from 20k to 10k.