This work was supported in part by a fellowship funding from the Fondation du CHUM for BRM.
The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy-induced thrombocytopenia
Article first published online: 7 JUN 2012
© 2012 American Association of Blood Banks
Volume 53, Issue 2, pages 306–314, February 2013
How to Cite
Rioux-Massé, B., Laroche, V., Bowman, R. J., Lindgren, B. R., Cohn, C. S., Pulkrabek, S. M. and McCullough, J. (2013), The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy-induced thrombocytopenia. Transfusion, 53: 306–314. doi: 10.1111/j.1537-2995.2012.03727.x
- Issue published online: 5 FEB 2013
- Article first published online: 7 JUN 2012
- Received for publication December 21, 2011; revision received April 23, 2012, and accepted April 23, 2012.
BACKGROUND: For patients with thrombocytopenia without bleeding risk factors, a platelet transfusion trigger of 10 × 109/L is recommended. No studies have evaluated the clinicians' decision-making process leading to trigger changes.
STUDY DESIGN AND METHODS: We report on the evaluation of trigger changes and the relation with bleeding. Eighty patients previously enrolled in the SPRINT trial represent the patient population for the current analysis.
RESULTS: Seventy-four patients had a starting trigger of 10 × 109/L. Only a minority of patients treated with chemotherapy alone (3/12, 25%) and autologous transplant (6/15, 40%) had a change in their trigger in contrast to the majority of allogeneic transplant (37/47, 79%; p = 0.001 and p = 0.009, respectively, when compared to allogeneic transplant group). Bleeding was the main reason reported by clinicians for a trigger change, but the occurrence of significant bleeding (Grade 2-4) was similar in patients with or without a trigger change (51 and 54%, p = 1.00). Clinicians were influenced by the bleeding system: Grade 1 mucocutaneous bleeding leading to a trigger change was overrepresented (71% of cases), as was Grade 2 genitourinary bleeding not leading to a trigger change (57% of cases).
CONCLUSION: A universal trigger of 10 × 109/L may not be maintained in a diverse population of patients with their respective bleeding risk factors. Because the trigger is changed often, it may not be as effective as previously believed.