Platelet transfusion therapy for medical and surgical patients
MAURIE MARKMAN, MD
MOHAMAD A. HUSSEIN, MDAddress reprint requests to M.A.H., Department of Hematology and Medical Oncology, T33, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
GERALD A. HOELTGE, MD
Platelet transfusions have become more common as more patients undergo bone marrow transplantation and aggressive chemotherapy for malignant diseases. This paper reviews the indications for platelet transfusions and the factors that can decrease their effectiveness.KEY POINTS
Drug- or radiation-induced megakaryocytic hypoplasia is the primary indication for platelet transfusion.
Thrombotic thrombocytopenia purpura, pre-eclampsia, and other platelet-mediated microangiopathies are contraindications to platelet transfusion.
Because amphotericin B can decrease platelet recovery and survival, doses of amphotericin B and platelet transfusions should be separated in time.
Alloimmunization should be suspected when a platelet transfusion fails to result in a corrected count increment ≥ 7500 per μL in a patient who has no clinical factors that would otherwise affect the results of platelet transfusion.
Febrile, nonhemolytic reactions are more frequent in platelet than in red cell transfusions, as are bacterial infections.
A stringent platelet transfusion policy is needed; recommended thresholds for platelet transfusion have ranged from 5000 per μL in stable amegakaryocytic patients to 100 000 per μL in patients undergoing neurologic or ophthalmologic surgery.