PLATELET TRANSFUSION AND ALTERNATIVES TO TRANSFUSION IN PATIENTS WITHMALIGNANCY

Platelet transfusions have long had an important role in the treatment of patients with thrombocytopenia due to disease or myelotoxic treatm ent or in patients with reduced platelet function, However, platelet t ransfusions are associated with numerous risks, both immunologic (e,g. , transfusion reactions, alloimmunization, immunosuppression) and infe ctious (e,g,, viral, bacterial), In addition, several laboratory and c linical factors can influence post-transfusion platelet recovery, Rece nt technological advances have introduced the potential for using alte rnatives to platelet transfusions, such as cytokines or platelet subst itutes, which may avoid the risks of transfusion, Platelet development from megakaryocytes is a process that is highly regulated by cytokine s and animal research suggests that selected cytokines involved in thi s process may be useful in the treatment of thrombocytopenia, Newer de velopments, including the utilization of recombinant cytokines with re latively selective stimulation of platelet production (e,g., interleuk in 6 [IL-6]) and the recent discovery of a megakaryocyte colony stimul ating factor (thrombopoietin), represent major therapeutic opportuniti es in the treatment of thrombocytopenia, Platelet substitutes, e,g,, t hromboerythrocytes, also show promise in the management of platelet de ficiencies.