Increased platelet transfusion requirement is associated with multiple organ dysfunctions in patients undergoing hematopoietic stem cell transplantation

Organ dysfunction following hematopoietic stem cell transplantation (HSCT) may be a manifestation of a systemic inflammatory response, We speculate th at part of the platelet transfusion requirement in HSCT patients results fr om this systemic inflammatory response, and increased transfusion requireme nt would be associated with, or precede, organ dysfunction, We studied 199 adults undergoing autologous (n = 173) or allogeneic (n = 26) HSCT. Patient s with CNS (P = 0.008) or pulmonary (P=0.002) dysfunction, or with VOD (P = 0.05) received a higher mean number of platelet transfusions per week than patients who did not have these dysfunctions, Furthermore, a higher number of platelet transfusions during any 1 week period was significantly associ ated with development of pulmonary (P = 0.0002) or renal (P < 0.0001) dysfu nction in the following week, This predictive value was strongest early in the HSCT course, but remained significant over all 4 weeks. In multivariate analysis the number of platelet transfusions during the previous week was independently predictive for development of pulmonary dysfunction in week 2 (P = 0.01) and week 3 (P = 0.055), We believe that occurrence of increased platelet transfusion requirement prior to onset of dysfunction is consiste nt with the concept that an antecedent inflammatory response results in bot h platelet consumption and various organ dysfunctions, Increased platelet t ransfusion requirement may act as an early marker of subsequent organ dysfu nction, Additionally, there may be a direct role of platelets in the develo pment and progression of organ dysfunction in HSCT patients.