Risks, costs, and alternatives to platelet transfusions

The use of platelet transfusions has increased greatly in the past decade a nd is likely to continue to escalate because of the risks of thrombocytopen ia in patients receiving dose-intensive cancer chemotherapy, the increased use of hematopoietic progenitor cell transplantation, and the prevalence of human immunodeficiency virus infection. Despite marked advances in procedu res for ensuring the safety of platelets, including intensive donor screeni ng, infectious disease marker testing, and increased use of leukodepletion techniques, platelet transfusions carry a significant risk for immunologic disorders and transmission of bacterial, viral, and perhaps other diseases and can entail a very high cost. In addition, thrombocytopenia has the pote ntial to interfere with delivery of chemotherapy on schedule and at the pla nned doses, thus potentially compromising treatment outcome. The limitation s of platelet transfusions have prompted the development of agents with the potential to stimulate platelet production and thus reduce or eliminate th e need for transfusions. Two such agents, interleukin-ll (IL-11) and thromb opoietin (TPO), have demonstrated promise in clinical trials. In November, 1997, IL-11 received FDA approval for the prevention of severe thrombocytop enia in high risk patients receiving myelosuppressive chemotherapy Thrombop oietic growth factors have the potential to greatly simplify and increase t he safety of transfusion medicine.