Patients Receiving Palifermin in Conjunction with Melphalan 200 Required Fewer Platelet Transfusions: Analysis of a Retrospective Cohort Study.

Abstract Background: Mucosal injury and concomitant associated side effects represents a major toxicity of autologous transplant for myeloma. The use of Palifermin has been demonstrated to reduce mucositis severity scores and duration in randomized trials. We sought to evaluate the effect of palifermin on overall platelet transfusion requirements as an indirect measure of reduced GI toxicity. Since palifermin has been shown to decrease mucosal damage caused by conditioning regimens for PBSCT, it was theorized that palifermin’s protective effects might lead to a reduction in the platelet transfusion requirements for these patients. Methods: Thirty six consecutive myeloma PBSCT patients conditioned with melphalan 200 mg/m2 plus palifermin (dosed per manufacturers recommendations) were retrospectively evaluated for platelet transfusion requirements following autologous transplant. As a historical control, data were retrospectively collected on thirty eight consecutive myeloma PBSCT patients conditioned with the same regimen prior to the routine use of palifermin. Platelet support consists of transfusion of leukoreduced irradiated single donor pheresis products. Platelet transfusions were dictated by standard clinical practice on the transplant service either for a routine platelet count <10K or 20k when patients had evidence for bleeding. Identical platelet transfusion criteria were used in the control and palifermin groups. The number of platelet transfusions required from the time of transplant until platelet recovery was analyzed for each patient. Patients who did not have adequate platelet recovery (Platelets <100,000) at the initiation of transplant conditioning were excluded from analysis in both groups. Results: The palifermin and control patients were of similar age and renal function. Baseline median platelet count was higher in the palifermin group (260 vs 213.5; p=.01), but both groups had mean platelet counts well above the normal range. Patients in the palifermin group required an average of 1.11 platelet transfusions compared with 2.42 transfusions for the control group (p=.055). In the palifermin group, 17 (46%) of the patients required no platelet transfusions compared to only 8 (21%) in the control group (p=.017). When analyzing only the patients who had normal platelet count (> 150,000) prior to start of the conditioning regimen, the palifermin patients (33) required an average of 1.1 transfusions compared to 1.7 transfusions in the control patients (33). The numbers of patients requiring only 1 transfusion were 11 (31%) in the palifermin group and 13 (34%) in the control group. The time to platelet engraftment was similar in both the 2 groups (14.5 days in the palifermin group and 15 days in the control group). Conclusion: The use of palifermin is associated with reduced platelet transfusion requirements among a group of patients who received melphalan 200 mg/m2 conditioning and autologous transplant for myeloma. Further cost analysis and quality of life analysis are needed to further justify this approach for all patients.

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An Increase in the Immature Platelet Fraction Predicts Reconstitution of the Platelet Count and May Reduce Prophylactic Platelet Transfusions after Stem Cell Transplantation.

Blood ◽

10.1182/blood.v104.11.3632.3632 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3632-3632

Author(s):

Samuel J. Machin ◽

Dan Hart ◽

Stefan Kunka ◽

Carol Briggs ◽

Laurence Corash

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Platelet Count ◽

Platelet Transfusion ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Transplant Patients ◽

Automated Method ◽

Immature Platelet Fraction ◽

Platelet Transfusions

Abstract A new automated method to reliably quantitate reticulated platelets, expressed as the immature platelet fraction (IPF), has been developed on an automated cell counter (XE-2100, Sysmex). The IPF is identified by flow cytometery using a polymethine dye, staining platelet RNA, in the reticulocyte channel; the results are available at the same time as the CBC. The IPF normal range is 1.1–6.1%, mean 3.4%, 2 SD 2.3%. Reproducibility and stability results over 48 hours were acceptable. The IPF is raised when there is increased peripheral consumption/destruction. In untreated idopathic thrombocytopenic purpura, n = 12, mean 22.3%, range 9.2–33.1% and active thrombotic thrombocytopenic purpura, n = 5, mean 17.2%, range 11.2–30.9%. Patients who may require prophylactic platelet transfusion, usually at threshold counts less than 10 x 109/L, to support periods of marrow aplasia were monitored daily for platelet count and IPF%. The recovery phase of thrombocytopenia in most chemotherapy (n=13) and stem cell/bone marrow transplant patients (n=15) was preceded by a rise in IPF% several days prior to platelet recovery, mean IPF 13.7%, range 7–27.3%. In particular, patients undergoing autologous transplantation (n=8) using peripherally collected stem cells have a very characteristic IPF% motif, with a rise 1 day prior to engraftment for all patients except one where it was 2 days prior. For bone marrow derived transplant patients the increase in IPF was more variable, the rise preceded the rise in platelet count by 2–7days. These patients suffer more septic episodes where there is a rise in the IPF with no immediate increase in the platelet count, and require more regular platelet transfusions. Following a platelet transfusion there is a 24-hour transitory fall in the IPF response, which may impede platelet recovery. A parameter that could predict the timing of platelet recovery could be used clinically to reduce the use of prophylactic platelet transfusion in these patients, thus minimising donor exposure, infection risk and allowing substantial financial savings. The IPF is a useful parameter in the evaluation of the thrombocytopenic patient and has the potential to allow more optimal transfusion of platelet concentrates.

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A Pilot Study to Evaluate the Feasibility of Anti-Fibrinolytic Agents in Reducing Hemorrhagic Complications in Pediatric Patients with Thrombocytopenia

Blood ◽

10.1182/blood-2020-134794 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 3-3

Author(s):

Meghan McCormick ◽

Meghan Delaney ◽

Cheryl A Hillery ◽

Ram Kalpatthi ◽

Darrell J Triulzi

Keyword(s):

Platelet Count ◽

Tranexamic Acid ◽

Platelet Transfusion ◽

Pediatric Patients ◽

Bleeding Complications ◽

Study Medication ◽

Fibrinolytic Agents ◽

Risk Of Bleeding ◽

Transfusion Requirements ◽

Platelet Transfusions

Background: The risk of bleeding remains high in thrombocytopenic pediatric hematology-oncology patients despite the use of prophylactic platelet transfusions. In one study, WHO grade 2 or higher bleeding occurred in >80% of pediatric subjects receiving hematopoietic stem cell transplantation or chemotherapy despite a platelet transfusion threshold of 10,000/µl. The risk of bleeding is not decreased with higher transfusion thresholds or increased platelet doses. Bleeding episodes are associated with increased mortality rates, greater utilization of resources and increased transfusion requirements. We examined the use of anti-fibrinolytic agents in decreasing bleeding events and platelet transfusions. Methods: We conducted a randomized double-blinded Phase 2 trial of tranexamic acid versus placebo in inpatient pediatric patients undergoing chemotherapy or HSCT expected to have prolonged thrombocytopenia. All patients admitted to the Oncology or HSCT services were screened for eligibility. Patients consenting for enrollment received either tranexamic acid 10m/kg/dose or normal saline every 8 hours while the platelet count as <30,000/ul until discharge or spontaneous platelet recovery (maximum 30 days). We conducted daily hemostatic assessments using the WHO bleeding scale and monitored adverse events and platelet transfusion requirements. Follow-up assessments took place at 7 and 30 days following completion of study medication. Primary aims were to assess safety and feasibility of tranexamic acid in children with hypoproliferative thrombocytopenia. Results: We screened 697 admissions over 11 months, 31 patients were eligible for enrollment. Enrollment was suspended in March 2020 for COVID reasons though screening continued through July 2020. An additional 10 eligible patients were identified in this period. The most common reasons for ineligibility included recent asparaginase administration, predicted inpatient stay <5 days and age ≤ 2 or ≥ 18 years. Eleven patients enrolled and completed all study procedures. There were no missed doses of medication, 88.4% of doses were administered within one hour of prescribed time. Patients remained on study for a mean of 11.1 days. Five patients each met criteria for spontaneous platelet count recovery or discharge, 1 patient received the study medication for 30 days. Bleeding (all grades) occurred on 29.5% of days. Grade 2 or higher bleeding occurred on 4.9% of days and was experienced by 27.3% of patients. The most common sites of bleeding were oral/nasal and cutaneous. Subjects received a median of 2 platelet transfusions per patient. There were no thromboembolic events or serious adverse events. Conclusion: Tranexamic acid is well tolerated can be safely administered to pediatric oncology patients as an adjunct to therapy. We are planning a multi-center randomized controlled trial to assess the efficacy of tranexamic acid in reducing bleeding complications in this population. Disclosures Triulzi: Fresenius Kabi: Consultancy; Cerus Corp: Research Funding. OffLabel Disclosure: Tranexamic Acid - This medication is being studied as an adjuvant to therapy to prevent bleeding complications and reduce platelet transfusions in pediatric patients with hypoproliferative thrombocytopenia.

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Thrombopoietic Agonists Show Efficacy in ITP Related to Allogeneic Stem Cell Transplantation,

Blood ◽

10.1182/blood.v118.21.3292.3292 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3292-3292 ◽

Cited By ~ 1

Author(s):

Emma M O'Donovan ◽

Katy Rezvani ◽

Jeremy Sargent ◽

Deborah Richardson ◽

Hannah Tharmalingam ◽

...

Keyword(s):

Stem Cells ◽

Stem Cell ◽

Platelet Count ◽

Platelet Transfusion ◽

Significant Rise ◽

Platelet Counts ◽

Transfusion Requirements ◽

Cell Transplants ◽

Clinically Significant ◽

Platelet Transfusions

Abstract Abstract 3292 Patients with refractory immune thrombocytopenia (ITP) have limited therapeutic options, with morbidity and mortality as often from infection as from bleeding. Thrombopoietin (TPO) mimetics allow an increase in the platelet count without causing immunosuppression. These agents may be especially useful in patients with secondary forms of ITP. We report three patients treated with TPO agonists for ITP post Allogeneic Stem Cell Transplants (SCT). Patient 1: MC, 37yrs, developed refractory ITP after a myeloablative allogeneic SCT for Accelerated Phase CML. He was unresponsive to standard treatments (figure 1a), requiring platelet transfusions 3x weekly for active bleeding. He started Eltrombopag 50mg/day in July 2009. He had a clinically significant increase in his platelet count (supported count increased to 40) so platelet transfusions were reduced to 2x weekly. Eltrombopag was increased to 75mg in November with a subsequent platelet increase to 90 and by December 2009 he was platelet independent, maintaining a platelet count 90–120 on Eltrombopag alone, 25mg/day, 5 days week. Patient 2: BT, 4yrs(12kg), underwent a myeloablative allogeneic PBSCT in September 2009 for JIA/HLH. She became thrombocytopenic in June 2010, presumed to be ITP. She had no response to prednisolone or rituximab and a only a minimal response to IVIG; requiring platelets 1x weekly. She started Eltrombopag 7mg OD in November 2010, escalated to 12mg by February 2011. This had a synergistic effect with IVIG and she became platelet independent after one month of Eltrombopag and IVIG, maintaining platelet counts 50–200 (figure1b). Patient 3: MG, 62yrs, underwent a reduced intensity allogeneic SCT in March 2010 for stage 3 Sezary syndrome. Post SCT he developed pancytopenia associated with EBV reactivation. He received daily GCSF, regular blood and weekly platelet transfusions. In July he developed GI bleeding from HSV colitis and his platelet transfusion requirements increased to alternate days. In October 2010 he was started on Romiplostim 250mcg, increased to 350mcg weekly, erythropoetin and GCSF. He had a clinically significant rise in his platelet counts and a reduction in his platelet requirements to 1x weekly within weeks of starting romiplostim. By December he was platelet independent, with counts persistently over 50, and romiplostim was stopped (figure1c). All three patients remain in remission at the time of submission of the abstract. Immune cytopenias are well-recognised post myeloablative allografts occurring in 5–37% of SCT recipients. The occurrence of ITP in SCT recipients has been reported, in which GVHD or the production of anti-platelet alloantibodies of recipient origin was considered to play major roles. Although small numbers, these case studies show efficacy of thrombopoietic agents (recently licensed for use in chronic ITP) in patients with thrombocytopenia post SCT refractory to standard therapies, with an early reduction and subsequent cessation in platelet transfusion requirements in all three patients. The lack of immune suppression with these agents may be particularly relevant in patients post SCT, in whom immune reconstitution is vital not only in preventing infections, but also in preventing rejection of the graft and in establishing a graft versus leukaemia effect. Given that TPO receptors are present on haematopoietic stem cells at all stages of development and that TPO provides a growth factor for stem cells, the use of these agents in patients treated for leukaemia requires caution. There was no evidence of progression of disease in these patients and TPO agents were only required for a period of time (patient 3 is off therapy and the others only receive minimal doses). Formal evaluation of these agents in allogeneic SCT is warranted. Disclosures: Cooper: GSK: Honoraria; Amgen: Honoraria.

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Characteristics and Financial Impact of Potentially Inappropriate Platelet Transfusion in the Inpatient Hospital Setting

Blood ◽

10.1182/blood-2019-125949 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2096-2096

Author(s):

Eric Mou ◽

Colin Murphy ◽

Jason Hom ◽

Lisa Shieh ◽

Neil Shah

Keyword(s):

Platelet Count ◽

Patient Care ◽

Platelet Transfusion ◽

Bypass Surgery ◽

Hospital Setting ◽

Financial Impact ◽

Platelet Counts ◽

Cardiac Bypass ◽

Platelet Defects ◽

Platelet Transfusions

Introduction Platelets are transfused prophylactically to prevent hemorrhage in a variety of patient populations. However, guidelines indicate that prophylactic platelet transfusions in patients with platelet counts above 50k/uL are usually not indicated, with notable exceptions including those undergoing neurological or cardiac bypass surgery. Common minor procedures such as paracentesis, central line placement, and lumbar puncture have been safely performed at platelet counts below 50k/uL. Despite this evidence, our institution incurred approximately 10 million dollars (USD) in direct platelet costs in 2017, with nearly 40% of platelet transfusions are occurring when the patient's platelet count exceeded 50k/uL. Given the significant financial impact of, and potential adverse effects associated with inappropriate platelet transfusion, we implemented a best practice advisory (BPA) in our electronic medical record (EMR) in order to better characterize patterns of platelet transfusion orders in patients with platelet counts >50k/uL. Methods An EMR-embedded BPA was activated in the inpatient hospital setting of a large, tertiary care academic medical center on May 1, 2019, and triggered whenever a platelet transfusion order was placed on an admitted patient whose most recent documented platelet count was >50k/ul. To inform the comparative impact of BPA alerts on provider behavior, alerts were randomized at the patient level to trigger either in standard or silent fashion. For standard alerts, the BPA appeared on-screen, informing the provider that their platelet transfusion order was potentially inappropriate and citing supportive evidence. Providers had the option of following or overriding the alert (Figure 1). In case of alert override, a pre-specified or free text justification was requested. Pre-specified options included upcoming neurosurgery, cardiac bypass surgery, known qualitative platelet defects, or patients taking antiplatelet drugs. Charge data were based on charges for platelet transfusion orders as listed in the hospital charge master. Results From May 1, 2019 to July 30, 2019, the alert fired 181 times (Figure 2). Alerts were silently triggered in 64 (35%) cases. Of the 117 active alerts, 23 (20%) were followed and 94 (80%) were overridden. The most common reasons for alert override included prophylactic transfusions ahead of non-cardiac and non-neurosurgical operations (18%), upcoming cardiac bypass surgery (18%), qualitative platelet defects (12%), active central nervous system (CNS) bleeding (12%), and active non-CNS bleeding (7%). The estimated cost savings associated with followed alerts was $18,170 USD. Discussion Our BPA was effective in reducing instances of platelet transfusion orders by 20% over a three-month period, translating to an estimated annual savings of nearly $70,000 USD in hospital charges. Conversely, the 80% alert override rate indicates that platelet transfusion in patients with platelet counts >50k/uL remains common, occurring in a variety of contexts. Potentially appropriate reasons for platelet transfusions included orders in the setting of cardiovascular bypass surgery, active CNS bleeding, or qualitative platelet defects, representing circumstances in which platelet thresholds are often set higher than 50k/uL. Alternatively, 25% of alert overrides occurred in potentially inappropriate contexts, including patients undergoing non-cardiovascular/non-neurosurgical procedures and patients with non-CNS active bleeding, settings where routinely targeting a platelet threshold >50k/uL is not supported by evidence. As a result of our study's randomized design, future directions include comparative analyses between patient care encounters in which alerts were silently versus visibly triggered, allowing for rigorous determination as to whether providers' interaction with our BPA influences subsequent rates of potentially inappropriate platelet utilization as compared to a control group. Overall, our findings show that platelets are frequently ordered in potentially inappropriate settings, and that reducing these orders imparts significant financial savings. These results provide an impetus for interventions directed at educating providers on appropriate platelet ordering practices, in order to further reduce unnecessary expenditures and optimize patient care. Disclosures No relevant conflicts of interest to declare.

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A randomized, placebo-controlled trial of intravenous gammaglobulin in alloimmunized thrombocytopenic patients

Blood ◽

10.1182/blood.v75.1.313.313 ◽

1990 ◽

Vol 75 (1) ◽

pp. 313-316 ◽

Cited By ~ 45

Author(s):

T Kickler ◽

HG Braine ◽

S Piantadosi ◽

PM Ness ◽

JH Herman ◽

...

Keyword(s):

Platelet Transfusion ◽

Controlled Trial ◽

Parameter Estimate ◽

Control Group ◽

Platelet Recovery ◽

Mean Values ◽

Blinded Study ◽

Before And After ◽

Study Population ◽

Intravenous Gammaglobulin

Abstract In a placebo-controlled, randomized blinded study, we evaluated the efficacy of intravenous gammaglobulin (IV-IgG) in alloimmunized thrombocytopenic patients. IV-IgG was administered at a dose of 400 mg/kg for 5 days. An incompatible platelet transfusion from the same donor was used before and after treatment. Seven patients received IV- IgG and five patients received placebo. Although platelet recovery in 1 to 6 hours was satisfactory in five patients after IV-IgG treatment, 24- hour survival was not improved in most patients. None of the patients receiving the placebo achieved satisfactory 1-hour platelet-corrected count increments (CCIs). By t test, the posttreatment mean values 1 hour after transfusion CCIs in the IV-IgG group were significantly greater than in the control group (8,413 v 1,050, P less than .007). Using a regression model to adjust for any distributional assumptions of the study population, the parameter estimate for IV-IgG treatment was positive, indicating that IV-IgG treatment is associated with higher CCIs. Although IV-IgG may improve 1-hour platelet recovery, clinical benefit was not demonstrated since 24-hour survival was not improved. IV-IgG treatment before unmatched platelet transfusions should not be considered as a replacement for HLA-compatible platelets in alloimmunized patients.

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Routine Prophylactic Platelet Transfusions Are Not Necessary for Patients in Clinically Stable Condition after Autologous Peripheral Stem Cell Transplantation(ASCT): Updated Results in 106 Patients.

Blood ◽

10.1182/blood.v104.11.3636.3636 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3636-3636

Author(s):

Kerstin Schaefer-Eckart ◽

Markus Frank ◽

Martin Wilhelm ◽

Hannes Wandt

Keyword(s):

Multiple Myeloma ◽

Stem Cell ◽

Platelet Count ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Platelet Transfusion ◽

Median Number ◽

Peripheral Stem Cell Transplantation ◽

New Strategy ◽

Platelet Transfusions

Abstract We present our extended experience with an only therapeutic platelet transfusion strategy in patients after autologous peripheral stem cell transplantation(ASCT). Clinically stable patients(fever < 38,5°Celsius, no local infections, no sepsis syndrome) received single donor apheresis platelet transfusions only in the case of bleeding WHO ≥ II°, while prophylactic platelet transfusions were given to clinically instable patients if the morning platelet count was < 10/nl. In a first analysis after 50 patients we have shown that this strategy was safe, with no bleeding greater than WHO II°. In a retrospective matched-pair analysis the total number of platelet units transfused was reduced to 50% compared to our former strategy with routine platelet transfusions given when the morning platelet count was below 10/nl. (ASH 2002). We now analysed 106 patients with a total number of 140 ASCTs. Median age was 54 years(19–70): The diagnoses were acute leukemia(17), lymphoma(34), solid tumors(9) and multiple myeloma(46). The conditioning regimens corresponded to standard protocols. Median days of thrombocytopenia < 20/nl and 10/nl were 6(0–92) and 3(0–62) respectively, with a total number of days with thrombocytopenia <20/nl and <10/nl of 989 and 508. Hemorrhages WHO I° and II° was observed in only 49 out of 140(35%) ASCTs. We observed no bleeding greater than WHO II°. The median number of platelet units was 1(0–18). 48 out of 140(34%) transplantations could be performed without platelet transfusions. In multiple myeloma this percentage was even higher: 32/68(47%). The indications for prophylactic transfusions were mainly FUO(21/61 – 34%) and mucositis with or without fever(19/61–31%). Considering age below or above the median age of 54 years or different diagnoses, there was no difference in days with platelets <10/nl, <20/nl, bleeding complications or median number of platelet units transfused. The total number of 234 transfusions in these 140 transplantations could have been even further reduced, because 15%(36/234) of the transfusions were given without a clear indication regarding the study regimen, because of a learning effect with this new strategy. This new strategy has shown to be very safe and prophylactic platetelet tansfusions are probably not necessary in clinically stable patients with fever as the only sign of an infection. We are just starting a multicenter randomised study comparing this new strategy with the former strategy of routine prophylactic platelet transfusion.

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Platelets Recovery and Transfusion Needs after Reduced Intensity Conditioning (RIC) Allogeneic Peripheral Blood Stem Cell (PBSC) Transplantation (allo-SCT).

Blood ◽

10.1182/blood.v108.11.2989.2989 ◽

2006 ◽

Vol 108 (11) ◽

pp. 2989-2989

Author(s):

Thomas Prebet ◽

Mohamad Mohty ◽

Patrick Ladaique ◽

Christian Chabannon ◽

Catherine Faucher ◽

...

Keyword(s):

Platelet Count ◽

Acute Gvhd ◽

Univariate Analysis ◽

Conditioning Regimen ◽

Platelet Recovery ◽

Gvhd Prophylaxis ◽

Study Population ◽

Grade 3 ◽

Few Data

Abstract Few data are currently available regarding platelets trasfusion needs and the kinetics and predicitive factors for platelets recovery after RIC allo-SCT. In this study, we analyzed the profile of platelets recovery and transfusion needs in the first 100 days after sibling PBSC RIC in a single institution series of 166 consecutive transplantations. Patients and graft characteristics were: age 49 y. (range: 18–70), diagnoses: 66 myeloid malignancies (40%), 64 lymphoid malignancies (39%), and 36 metastatic solid tumors (21%). 112 pts (67%) received an ATG-based RIC, while 54 pts (33%) received a low dose irradiation-based RIC. 75 pts (45%) developed grade 2–4 acute GVHD. Platelets recovery (>20 G/L) was observed at a median of 9 days (range: 0–99). The kinetics profile of platelets recovery is shown in the figure below. In the whole study population, the nadir was observed around day +7 after allo-SCT, and a plateau was reached about day +35. Filtered and irradiated donor apheresis platelets were used and patients needed a median of 1 unit (range: 0–53). In this series, 83 pts (50%) did not require any platelets transfusion during the follow-up period (median follow-up: 442 days) and 83 patients (50%) received at least one transfusion of platelets (54 were not transfused beyond day +100 after allo-SCT). Platelets count prior to RIC allo-SCT (median count 144 G/L; HR 0.44 (0.28–0.7) p=0.002), conditioning regimen (use of ATG; HR 1.86 (1.08–3.2) p=0.025) and the occurrence of acute (HR 1.54 (1.17–2.01); p=0.001) and severe GVHD (HR 2.36 (1.38–3.05) p=0.0006; 82% of patients with grade 3–4 acute GVHD were transfused) were the parameters significantly associated with platelets transfusion needs in multivariate analysis. In this cohort, 145 pts could be assessed for platelets recovery at day +100: among them, 99 (68%) had a platelet count >99 G/L. Univariate analysis found a significant impact of acute GVHD (p=0.0001) and platelet count prior to conditioning (p=0.012) but only acute GVHD (HR 5.52 (2.48–12.25); p=0.001) was associated with a delayed platelet recovery in a multivariate model. No impacts of pathology, GVHD prophylaxis regimen or CD34+ cell dose were demonstrated. Overall, these observations show a significantly lower rate of platelets transfusions and a quicker kinetic of platelets recovery after RIC allo-SCT and point out the effect of acute GVHD. In addition, considering the low level of myeloablation observed, RIC could be an appropriated field of investigation for the testing of megakaryocytic stimulating agents, towards further improving the safety and outcome of RIC allo-SCT. Platelets recovery after PBSC RIC allo-SCT Platelets recovery after PBSC RIC allo-SCT

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The Use Of Platelet Transfusions In The Intensive Care Unit and Impact On Platelet Count: A 30,000 Patient Registry Study

Blood ◽

10.1182/blood.v122.21.1154.1154 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1154-1154

Author(s):

Shuoyan Ning ◽

Rebecca Barty, MLT ◽

Yang Liu ◽

Nancy Heddle ◽

Donald Arnold

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Platelet Count ◽

Research Funding ◽

Platelet Transfusion ◽

Large Cohort ◽

Clinical Effects ◽

Icu Patients ◽

Icu Admission ◽

Platelet Transfusions

Abstract Background Thrombocytopenia is a common complication of critical illness and an independent risk factor for bleeding and death in the intensive care unit (ICU). Platelet transfusions are commonly used to improve platelet counts; however, the expected platelet increment from a transfusion in this setting has not been established. The objective of this study was to describe the frequency of platelet transfusion administration and their effect on platelet count increments in a large cohort of non-oncology critically ill adults. Methods We performed an analysis of a registry database, which was developed to capture clinical and laboratory data on all blood transfusions administered in 3 academic hospitals in Hamilton, Ontario, Canada. We included all patients ≥18 years who received one or more platelet transfusion during an ICU admission. Data validation was done by integrity checks with medical records and laboratory information system performed by a biostatistician. Non-transfused ICU patients were used as controls. The absolute increment in platelet count was calculated for each single platelet transfusion using the closest platelet count taken within 24 hours before the transfusion and 4-24 hours after the transfusion. Results Between April 2006 and October 2012, 33,222 patients were admitted to ICU, including 29,511 (88.8%) who did not have a diagnosis of cancer. Of those, 4,502 (15.3%) received one or more platelet transfusion during any ICU admission (n=4,690); 31.9% were female and median age at the time of first admission was 69 years (IQR 59-77). Among the 25,009 non-transfused patients admitted to ICU during the same period, 38.1% were female and the median age was 65 years (IQR 52–76). Median pre-transfusion platelet count was 87 x109/L (IQR 59-131) and a single platelet transfusion resulted in a median platelet count increment of 21 x109/L (IQR 6-40) as measured 6.7 hours (IQR 5.1-9.8) after the transfusion. There were 277 (25.4%) transfusions that yielded a platelet count increment of 5 x109/L or less. ICU mortality was 562/4,690 (12.4%) for patients who received a platelet transfusion, compared with 2,251/33,033(6.8%) for patients who were not transfused during their ICU stay. Summary/Conclusion Among this large cohort of non-oncology ICU patients, platelet transfusions were commonly administered for thrombocytopenia that was generally mild. In this setting one platelet transfusion resulted in a median platelet count rise of 21 x109/L. Many transfusion episodes yielded no appreciable increase in platelet count. Further studies are needed to determine the clinical effects of platelet transfusion in this setting controlling for confounding. Disclosures: Heddle: CIHR: Research Funding; Canadian Blood Services: Membership on an entity’s Board of Directors or advisory committees; Health Canada: Research Funding; Macopharma: Consultancy; ASH: Honoraria.

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Immature Platelet Fraction: A Useful Marker for Identifying the Cause of Thrombocytopenia and Predicting Platelet Recovery

Blood ◽

10.1182/blood-2018-99-113202 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 128-128

Author(s):

Young Kyung Lee ◽

Kibum Jeon ◽

Miyoung Kim ◽

Eunyup Lee ◽

Jiwon Lee ◽

...

Keyword(s):

Platelet Count ◽

Cancer Patients ◽

The Other ◽

Discriminatory Power ◽

Control Group ◽

Platelet Recovery ◽

P Values ◽

Platelet Counts ◽

Immature Platelet Fraction ◽

The Difference

Abstract Introduction: The assessment of thrombopoietic activity in bone marrow is necessary for patients with thrombocytopenia to achieve correct diagnoses and effective treatments. We evaluated the discriminatory power of the immature platelet fraction (IPF%) in differentiating hyperdestructive/consumptive thrombocytopenia from hypoproductive thrombocytopenia, and its potential use as a predictive marker for platelet recovery. Methods: Platelet indices including IPF% were measured in 105 healthy individuals (the control group), 31 patients with hyperdestructive/consumptive thrombocytopenia (14 with immune thrombocytopenic purpura [ITP] and 17 with liver cirrhosis), and 34 patients with hypoproductive thrombocytopenia (4 with aplastic anemia and 30 with cancer who were undergoing chemotherapy) by using a Sysmex XN-3000 hematology analyzer. Results: The platelet number in the hyperdestructive/consumptive thrombocytopenia group was significantly lower than that in the hypoproductive thrombocytopenia group (P <0.001). The difference of plateletcrit (PCT) between the 2 thrombocytopenia groups was not statistically significant (P= 0.363). The IPF% was significantly higher in the hyperdestructive/consumptive thrombocytopenia group (median: 6.2% [IQR 4.3-10.3%]) than in both the control group (1.8% [1.3-2.4%]) and the hypoproductive thrombocytopenia group (1.8% [0.9-2.3%]) (all P-values < 0.001). However, the difference between the hypoproductive thrombocytopenia and control groups was not statistically significant (P= 0.331). Compared to the control group, the hyperdestructive/consumptive thrombocytopenia group showed a 190.5% increase in the median IPF% value, while the hypoproductive thrombocytopenia group showed a 9.5% decrease. The IPF# was significantly different between the 3groups; it was highest in the control group (median: 4.3 ×109/L [IQR 3.5-5.8×109/L]), followed by the hyperdestructive/consumptive thrombocytopenia group (3.2×109/L [1.7-4.5×109/L]), and lowest in the hypoproductive thrombocytopenia group (1.3 ×109/L [0.7-2.0×109/L]) (all P-values <0.001). Compared to the control group, the hyperdestructive/consumptive thrombocytopenia group showed a 25.6% decrease and the hypoproductive thrombocytopenia group a 69.8% decrease. PDW, MPV, and P-LCR were higher in the hyperdestructive/consumptive thrombocytopenia group (14.5 ± 3.0 fL, 12.0 fL [IQR: 11.0-12.0 fL], and 38.9 ± 6.8%, respectively) than in the other 2 groups, but there was no statistical difference between the other 2 groups. The IPF% in the hyperdestructive/consumptive group increased significantly as the number of platelets decreased, especially in patients with severe thrombocytopenia with platelet counts under 40.0 ×109/L. The IPF% was 4.7% (3.1-4.7%), 6.2% (3.2-7.6%), and 11.4% (7.1-16.6%) in patients with platelet counts>90.0 ×109/L, 40.0-90.0 ×109/L and<40.0 ×109/L, respectively (P = 0.010). However, this phenomenon was not observed in the hypoproductive thrombocytopenia group. The area under the curve (AUC) was highest for IPF% (0.938), indicating that this parameter showed the best discriminatory ability between the 2 groups, followed by PDW (0.885), P-LCR (0.859), IPF# (0.827), and MPV (0.824) (all P-values <0.001). The best IPF% cut-off value indicative of the highest sensitivity and specificity was 2.3%. The AUC of PCT was under 0.5 (0.445, P = 0.477), showing no discriminatory power. The IPF% decreased 3-4 days in advance of platelet count elevation in patients with ITP, while the IPF# ratio (compared to baseline) increased 3 days in advance of the same. Furthermore, the IPF% and IPF# ratio increased 5.5 days and 8.5 days, respectively, before platelet counts increased up to 130.0 × 109/L in cancer patients receiving chemotherapy. Conclusion: IPF% showed the most % value difference between the 3 groups and the largest AUC, showing it has the best discriminatory power in distinguishing the cause of thrombocytopenia. Also, IPF% showed an inverse correlation with platelet count in the hyperdestructive/consumptive thrombocytopenia group, but not in the hypoproductive thrombocytopenia group. The IPF% and IPF# were useful markers to predict the elevation of platelet count in advance in ITP and in cancer patients receiving chemotherapy. Disclosures No relevant conflicts of interest to declare.

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Evaluation of four methods for platelet compatibility testing

Blood ◽

10.1182/blood.v69.5.1425.bloodjournal6951425 ◽

1987 ◽

Vol 69 (5) ◽

pp. 1425-1430

Author(s):

JG McFarland ◽

RH Aster

Keyword(s):

Platelet Transfusion ◽

Statistical Significance ◽

51Cr Release ◽

Hla Antibodies ◽

Platelet Suspension ◽

Platelet Recovery ◽

Single Donor ◽

Hla Compatibility ◽

Matched Donor ◽

Platelet Transfusions

Four platelet compatibility assays were performed on serum and platelet or lymphocyte samples from 38 closely HLA-matched donor/recipient pairs involved in 55 single-donor platelet transfusions. The 22 patients studied were refractory to transfusions of pooled random-donor platelets. Of the four assays (platelet suspension immunofluorescence, PSIFT; 51Cr release; microlymphocytotoxicity; and a monoclonal anti-IgG assay, MAIA), the MAIA was most predictive of platelet transfusion outcome (predictability, 74% for one-hour posttransfusion platelet recovery and 76% for 24-hour recovery). The only other assay to reach statistical significance was the PSIFT (63% predictability for one-hour posttransfusion recovery). The degree of HLA compatibility between donor and recipient (exact matches v those utilizing cross-reactive associations) was unrelated to the ability of the MAIA to predict transfusion results. The MAIA may be capable of differentiating HLA antibodies, ABO antibodies, and platelet-specific antibodies responsible for failure of HLA-matched and selectively mismatched single-donor platelet transfusions.

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