DELAYED ALLOIMMUNISATION BY RANDOM SINGLE DONOR PLATELET TRANSFUSIONS A Randomised Study to Compare Single Donor and Multiple Donor Platelet Transfusions in Cancer Patients with Severe Thrombocytopenia

The Lancet ◽  
1981 ◽  
Vol 317 (8223) ◽  
pp. 750-754 ◽  
Author(s):  
K SINTNICOLAAS
Keyword(s):  
Cancer Patients ◽  
Severe Thrombocytopenia ◽  
Randomised Study ◽  
Single Donor ◽  
Platelet Transfusions

scholarly journals A prospective randomized trial of HLA-matched versus mismatched single-donor platelet transfusions in cancer patients

Cancer ◽  
1988 ◽  
Vol 62 (4) ◽  
pp. 795-801 ◽  
Author(s):  
Gerald L. Messerschmidt ◽  
Robert Makuch ◽  
Fred Appelbaum ◽  
Richard S. Ungerleider ◽  
Ross Abrams ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cancer Patients ◽  
Prospective Randomized Trial ◽  
Single Donor ◽  
Platelet Transfusions

scholarly journals Platelet Transfusion Therapy

2017 ◽  
Vol 6 (2) ◽  
pp. 40-46
Author(s):  
Shanaz Karim ◽  
Ehteshamul Hoque ◽  
Mazharul Hoque ◽  
Md Mahmudur Rahman Siddiqui
Keyword(s):  
Severe Thrombocytopenia ◽  
Platelet Concentrates ◽  
Transfusion Therapy ◽  
Medical College ◽  
The Past ◽  
Single Donor ◽  
Increased Risk ◽  
The Many ◽  
Risk For Bleeding ◽  
Platelet Transfusions

Patients with severe thrombocytopenia are presumed to be at increased risk for bleeding, and consequently it has been standard practice for the past four decades to give allogeneic platelet transfusions to severely thrombocytopenic patients as supportive care. Platelet transfusions may be given either prophylactically to reduce the risk of bleeding, in the absence of clinical hemorrhage (prophylactic transfusions), or to control active bleeding when present (therapeutic transfusions). Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood, which are pooled before administration, or by apheresis from single donors. Comparative studies have shown that the post transfusion increments, hemostatic benefit, and side effects are similar with either product. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are preferred when histocompatible platelet transfusions are needed. Both preparations can be stored for up to 5 days after collection at 20°C to 24°C with good maintenance of platelet viability. It is now uncommon for patients undergoing intensive chemotherapy or bone marrow transplantation to die of hemorrhage, but it is open to debate as to what degree platelet transfusions have been responsible for this change in outcome, given the many other advances in other aspects of supportive care.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 40-46

scholarly journals Challenges and Advances in Managing Thrombocytopenic Cancer Patients

2021 ◽  
Vol 10 (6) ◽  
pp. 1169
Author(s):  
Avi Leader ◽  
Liron Hofstetter ◽  
Galia Spectre
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Solid Tumors ◽  
Bleeding Risk ◽  
Severe Thrombocytopenia ◽  
Treatment Dose ◽  
Antifibrinolytic Drugs ◽  
Anticancer Treatment ◽  
Antithrombotic Medication ◽  
Platelet Transfusions

Cancer patients have varying incidence, depth and duration of thrombocytopenia. The mainstay of managing severe chemotherapy-induced thrombocytopenia (CIT) in cancer is the use of platelet transfusions. While prophylactic platelet transfusions reduce the bleeding rate, multiple unmet needs remain, such as high residual rates of bleeding, and anticancer treatment dose reductions/delays. Accordingly, the following promising results in other settings, antifibrinolytic drugs have been evaluated for prevention and treatment of bleeding in patients with hematological malignancies and solid tumors. In addition, Thrombopoeitin receptor agonists have been studied for two major implications in cancer: treatment of severe thrombocytopenia associated with myelodysplastic syndrome and acute myeloid leukemia; primary and secondary prevention of CIT in solid tumors in order to maintain dose density and intensity of anti-cancer treatment. Furthermore, thrombocytopenic cancer patients are often prescribed antithrombotic medication for indications arising prior or post cancer diagnosis. Balancing the bleeding and thrombotic risks in such patients represents a unique clinical challenge. This review focuses upon non-transfusion-based approaches to managing thrombocytopenia and the associated bleeding risk in cancer, and also addresses the management of antithrombotic therapy in thrombocytopenic cancer patients.

scholarly journals Current management of cancer-associated venous thromboembolism in patients with thrombocytopenia: a retrospective cohort study

2021 ◽  
Author(s):  
Alessandro Squizzato ◽  
Silvia Galliazzo ◽  
Elena Rancan ◽  
Marina Di Pilla ◽  
Giorgia Micucci ◽  
...  
Keyword(s):  
Platelet Count ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Cerebral Metastasis ◽  
Bleeding Complications ◽  
Severe Thrombocytopenia ◽  
Regression Analyses ◽  
Multivariate Logistic Regression ◽  
Current Management

AbstractOptimal management of venous thromboembolism (VTE) in cancer patients with thrombocytopenia is uncertain. We described current management and clinical outcomes of these patients. We retrospectively included a cohort of cancer patients with acute VTE and concomitant mild (platelet count 100,000–150,000/mm3), moderate (50,000–99,000/mm3), or severe thrombocytopenia (< 50,000/mm3). Univariate and multivariate logistic regression analyses explored the association between different therapeutic strategies and thrombocytopenia. The incidence of VTE and bleeding complications was collected at a 3-month follow-up. A total of 194 patients of whom 122 (62.89%) had mild, 51 (26.29%) moderate, and 22 (11.34%) severe thrombocytopenia were involved. At VTE diagnosis, a full therapeutic dose of LMWH was administered in 79.3, 62.8 and 4.6% of patients, respectively. Moderate (OR 0.30; 95% CI 0.12–0.75), severe thrombocytopenia (OR 0.01; 95% CI 0.00–0.08), and the presence of cerebral metastasis (OR 0.06; 95% CI 0.01–0.30) were independently associated with the prescription of subtherapeutic LMWH doses. Symptomatic VTE (OR 4.46; 95% CI 1.85–10.80) and pulmonary embolism (OR 2.76; 95% CI 1.09–6.94) were associated with the prescription of full therapeutic LMWH doses. Three-month incidence of VTE was 3.9% (95% CI 1.3–10.1), 8.5% (95% CI 2.8–21.3), 0% (95% CI 0.0–20.0) in patients with mild, moderate, and severe thrombocytopenia, respectively. The corresponding values for major bleeding and mortality were 1.9% (95% CI 0.3–7.4), 6.4% (95% CI 1.7–18.6), 0% (95% CI 0.0–20.0) and 9.6% (95% CI 5.0–17.4), 48.2% (95% CI 16.1–42.9), 20% (95% CI 6.6–44.3). In the absence of sound evidence, anticoagulation strategy of VTE in cancer patients with thrombocytopenia was tailored on an individual basis, taking into account not only the platelet count but also VTE presentation and the presence of cerebral metastasis.

Metalloproteinase inhibitors improve the recovery and hemostatic function of in vitro–aged or –injured mouse platelets

Blood ◽  
2003 ◽  
Vol 102 (12) ◽  
pp. 4229-4235 ◽  
Author(s):  
Wolfgang Bergmeier ◽  
Peter C. Burger ◽  
Crystal L. Piffath ◽  
Karin M. Hoffmeister ◽  
John H. Hartwig ◽  
...  
Keyword(s):  
Shape Change ◽  
Surface Expression ◽  
Severe Thrombocytopenia ◽  
Aged Mouse ◽  
Platelet Concentrates ◽  
Duration Of Treatment ◽  
Mitochondrial Injury ◽  
Metalloproteinase Activity ◽  
Platelet Transfusions

Abstract Platelet transfusions are a crucial component of support for patients with severe thrombocytopenia. Storage of platelet concentrates, however, is associated with a reduction in platelet posttransfusion recovery and hemostatic function. In this study, we established a model of mitochondrial injury that resembles platelet storage lesion. Mitochondrial injury, provoked by incubation of platelets with carbonyl cyanide m-chlorophenylhydrazone (CCCP), led to reduced posttransfusion recovery in mice, an effect that directly correlated with the duration of treatment. Damaged platelets were characterized by shape change, disruption of membrane asymmetry, surface expression of P-selectin, and profound proteolysis of GPIbα. Using our model, we identified a key role for endogenous metalloproteinase(s) in platelet clearance, as their inhibition markedly improved posttransfusion recovery of both the mitochondria-injured and in vitro-aged mouse platelets. Metalloproteinase inhibition also prevented proteolysis of GPIbα on damaged platelets, thereby improving the hemostatic function of these cells in vivo. We propose that inhibition of metalloproteinase activity during storage could significantly improve the effectiveness of platelet transfusions. Surface expression of GPIbα might be a powerful marker to determine the quality of platelet concentrates, because it reflects metalloproteinase activity in vitro. (Blood. 2003;102: 4229-4235)

scholarly journals Delayed alloimmunization using random single donor platelet transfusions: a prospective study in thrombocytopenic patients with acute leukemia

Blood ◽  
1983 ◽  
Vol 62 (2) ◽  
pp. 473-479 ◽  
Author(s):  
J Gmur ◽  
A von Felten ◽  
B Osterwalder ◽  
H Honegger ◽  
A Hormann ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Prospective Study ◽  
Randomized Study ◽  
Platelet Concentrates ◽  
Single Donor ◽  
Time Period ◽  
A Prospective Study ◽  
Platelet Transfusions

Abstract A randomized study was performed in 54 thrombocytopenic patients with acute leukemia. Alloimmunization of recipients of random multiple-donor platelet concentrates (MD group) was compared to that of patients receiving random single-donor platelets (SD group). In the SD patients, formation of alloantibodies (mostly anti-HLA) occurred less frequently (p less than 0.002), after a longer time period (p less than 0.002), and after a higher number of transfusions (p less than 0.005) as compared to MD patients. SD patients also became refractory to random platelets less frequently (p less than 0.005), after a longer time period, and after a higher number of transfusions (p less than 0.02). In SD patients, the increments after the first and the last transfusion were in the same range, whereas in MD patients, the 1-hr (p less than 0.001) and the 24-hr (p less than 0.025) increments decreased from the first to the last transfusion. Thus, the use of random SD platelet transfusions postponed alloimmunization.

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