The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy-induced thrombocytopenia

Authors

  • Benjamin Rioux-Massé,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Vincent Laroche,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Robert J. Bowman,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Bruce R. Lindgren,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Claudia S. Cohn,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Shelley M. Pulkrabek,

    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
    Search for more papers by this author
  • Jeffrey McCullough

    Corresponding author
    1. From the Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Institute for Engineering in Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; the Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec, Canada; and the Centre de Recherche FRSQ du Centre Hospitalier affilié Universitaire de Québec, Québec, Quebec, Canada.
      Jeffrey McCullough, MD, Laboratory Medicine & Pathology, University of Minnesota—MMC 609, 420 Delaware Street SE, Minneapolis, MN 55455; e-mail: mccul001@umn.edu.
    Search for more papers by this author

  • This work was supported in part by a fellowship funding from the Fondation du CHUM for BRM.

Jeffrey McCullough, MD, Laboratory Medicine & Pathology, University of Minnesota—MMC 609, 420 Delaware Street SE, Minneapolis, MN 55455; e-mail: mccul001@umn.edu.

Abstract

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.

Ancillary