Address reprint requests to: Thomas R. Klumpp, MD, Associate Professor of Medicine, Temple University Cancer Center, 3322 North Broad Street, Philadelphia, PA 19140.
Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double-blind trial
Article first published online: 25 APR 2002
Volume 39, Issue 7, pages 674–681, July 1999
How to Cite
Klumpp, T.R., Herman, J.H., Gaughan, J.P., Russo, R.R., Christman, R.A., Goldberg, S.L., Ackerman, S.J., Bleecker, G.C. and Mangan, K.F. (1999), Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double-blind trial. Transfusion, 39: 674–681. doi: 10.1046/j.1537-2995.1999.39070674.x
Supported in part by Baxter Healthcare Corporation.
- Issue published online: 25 APR 2002
- Article first published online: 25 APR 2002
- Received: 04 August 1998; Accepted: 03 February 1998
- HDP(s) = higher-dose platelet component(s);
- HPCT = hematopoietic progenitor cell transplantation;
- LDP(s) = lower-dose platelet component(s)
BACKGROUND: The dose-response relationship for platelet transfusion has become increasingly important as the use of platelet transfusion has grown.
STUDY DESIGN AND METHODS: One hundred fifty-eight prophylactic apheresis platelet transfusions were administered to 46 patients undergoing high-dose therapy followed by hematopoietic progenitor cell transplantation in a prospective, randomized, double-blind, multiple-crossover study. Transfusions were administered in pairs, differing only in platelet content. Each pair consisted of a lower-dose platelet component (LDP) and a higher-dose platelet component (HDP) administered in random order to the same patient. LDPs contained a mean of 3.1 × 1011 platelets (range, 2.3-3.5 × 1011), and HDPs contained a mean of 5.0 × 1011 platelets (range, 4.5-6.1 × 1011). Patients with active bleeding and those who were refractory to platelet transfusions were excluded.
RESULTS: The mean posttransfusion platelet count increment with LDP was 17,010 per μL, and that with HDP was 31,057 per μL (p<0.0001). Only 37 percent of LDPs resulted in platelet count increments of at least 20,000 per μL, whereas 81 percent of HDPs resulted in increments above this level (p<0.0001). The mean transfusion-free interval with LDP was 2.16 days, whereas that with HDP was 3.03 days (p<0.01). Administration of LDPs was associated with a 39 to 82 percent increase in the relative risk (per day) of requiring subsequent platelet transfusions (p<0.0001).
CONCLUSION: As compared to the administration of HDPs, the administration of LDPs for prophylactic transfusion in hematopoietic progenitor cell transplant patients results in a lower platelet count increment, a lower likelihood of obtaining a posttransfusion platelet increment >20,000 per μL, a shorter transfusion-free interval, and a greater relative risk per day of requiring additional transfusions.