Lowering the prophylactic platelet transfusion threshold: A prospective analysis

The 20 x 10(9)/L threshold for prophylactic platelet transfusion may be unn ecessarily high. Few prospective studies. however, in which other trigger v alues were tested have been published. In this study all hospitalized, thro mbocytopenic adult hematology-oncology patients in our institution were pro spectively evaluated daily for hemorrhage and platelet transfusion during a one year period; no patients were excluded for bleeding or infectious prob lems. By design, during the initial six-months: (baseline period), the prop hylactic platelet transfusion trigger was 20 x 10(9)/L; for the second six- months (study period) this threshold was changed to 10 x 10(9)/L. Patients studied during the two periods did not differ significantly in age, gender. diagnosis. blood or marrow transplant status, and duration of neutropenia. Compliance with the thresholds was 95.6% (baseline period) and 93.5% (stud y period). For patients with platelet counts under 20 x 10(9)/L. the mean u se of platelet transfusions per patient per day was significantly lower in the study period (4.47) than in the baseline period (6.48: p<0.001). Both m ean prophylactic (1.54/patient-day) and therapeutic (2.93/patient-day) plat elet transfusions were reduced in the study period compared with the baseli ne period (2.16 and 4.22/patient-day, respectively). Hemorrhage was slightl y reduced in the study period compared with the baseline period: major hemo rrhage, 15.2% vs. 18.4% (p=0.014): minor hemorrhage. 63.6% vs. 70.1% (p<0.0 01). Thus, hemorrhage was not increased with the lower trigger level. A 10 x 10(9)/L prophylactic platelet transfusion threshold value is safe and eff ective.