How well do platelets prevent bleeding?

Abstract

Prophylactic platelet transfusions are used to reduce the risk of spontaneous bleeding in patients with treatment- or disease-related severe thrombocytopenia. A prophylactic platelet-transfusion threshold of <10 × 103/µL has been shown to be safe in stable hematology/oncology patients. A higher threshold and/or larger or more frequent platelet doses may be appropriate for patients with clinical features associated with an increased risk of bleeding such as high fevers, sepsis, disseminated intravascular coagulation, anticoagulation therapy, or splenomegaly. Unique factors in the outpatient setting may support the use of a higher platelet-transfusion threshold and/or dose of platelets. A prophylactic platelet-transfusion strategy has been shown to be associated with a lower risk of bleeding compared with no prophylaxis in adult patients receiving chemotherapy but not for autologous transplant recipients. Despite the use of prophylactic platelet transfusions, a high incidence (50% to 70%) of spontaneous bleeding remains. Using a higher threshold or larger doses of platelets does not change this risk. New approaches to reduce the risk of spontaneous bleeding, including antifibrinolytic therapy, are currently under study.

Graphical abstract

Figure 1.

Days with bleeding of grade 2 or higher in all 3 treatment groups, according to morning platelet-count categories. Days with bleeding of grade 2 or higher in all 3 treatment groups, according to morning platelet-count categories. The percentage of days on which patients had bleeding of grade 2 or higher is shown, along with the associated 95% confidence intervals (dashed lines), according to the morning platelet-count category. Data are based on the 24 309 days during the study period on which patients had both a morning platelet count and information on bleeding of grade 2 or higher. Reprinted from Slichter et al with permission.