Platelet transfusion for patients with cancer: Clinical practice guidelines of the American Society of Clinical Oncology

Objective: To determine the most effective, evidence-based approach to the use of platelet transfusions in patients with cancer. Outcomes: Outcomes of interest included prevention of morbidity and mortali ty from hemorrhage, effects on survival, quality of life, toxicity reductio n, and cost effectiveness. Evidence: A complete MedLine search was performed of the past 20 years of t he medical literature. Keywords included platelet transfusion, alloimmuniza tion, hemorrhage, threshold and thrombocytopenia. The search was broadened by articles from the bibliographies of selected articles. Values: Levels of evidence and guideline grades were rated by a standard pr ocess. More weight was given to studies that tested a hypothesis directly r elated to one of the primary outcomes in a randomized design. Benefits/Harms/Cost: The possible consequences of different approaches to t he use of platelet transfusion were considered in evaluating a preference f or one or another technique producing similar outcomes. Cost alone was not a determining factor. Recommendations: Appendix A summarizes the recommendations concerning the c hoice of particular platelet preparations, the use of prophylactic platelet transfusions, indications for transfusion in selected clinical situations, and the diagnosis, prevention, and management of refractoriness to platele t transfusion. Validation: Five outside reviewers, the ASCO Health Services Research Commi ttee, and the ASCO Board reviewed this document. Sponsor: American Society of Clinical Oncology J Clin Oncol 19:1519-1538. ( C) 2001 by American Society of Clinical Oncology.