The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy

Summary. Indications for platelet transfusion remain controversial and are frequently based on arbitrary numerical criteria. In October 2000, we introduced a stringent prophylactic‐platelet transfusion policy < 10 × 10 9 /l for stable patients and < 20 × 10 9 /l in the presence of major bleeding or additional risk factors. A trigger of < 50 × 10 9 /l was introduced for patients undergoing invasive procedures. A prospective analysis was performed measuring the frequency of minor and major bleeding events, morbidity, mortality and duration of pancytopenia. Blood product usage was assessed and health care savings measured. A total of 98 patients were evaluated on 2147 patient study days and 271 bleeding episodes were recorded. Major bleeding occurred on 1·39% (30/2147) of the study days when platelet counts were < 10 × 10 9 /l and 2·3% (50/2147) of the study days when platelet counts were 10–20 × 10 9 /l. In patients with platelets > 20 × 10 9 /l, there were 117 major bleeding episodes observed on 5·4% of the study days. In patients with no identified additional risk factors present, major haemorrhages were recorded in 0·51% (11/2147) of the study days in patients with platelet counts ≥ 10 × 10 9 /l. There was a 36% reduction in platelet units transfused compared with retrospective data when an arbitrary transfusion trigger of 20 × 10 9 /l was in place ( P  = < 0·02). Of note, a 16% reduction in red cell transfusions was recorded. These data confirm that the introduction of a transfusion trigger of < 10 × 10 9 /l in the absence of fresh bleeding and sepsis (> 38°C) is safe and has a significant impact on overall hospital transfusion costs.