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Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double‐blind trial
Author(s) -
Klumpp T.R.,
Herman J.H.,
Gaughan J.P.,
Russo R.R.,
Christman R.A.,
Goldberg S.L.,
Ackerman S.J.,
Bleecker G.C.,
Mangan K.F.
Publication year - 1999
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.1999.39070674.x
Subject(s) - platelet , medicine , platelet transfusion , apheresis , crossover study , randomized controlled trial , blood product , prospective cohort study , anesthesia , surgery , gastroenterology , alternative medicine , pathology , placebo
BACKGROUND: The dose‐response relationship for platelet transfusion has become increasingly important as the use of platelet transfusion has grown. STUDY DESIGN AND METHODS: One hundred fifty‐eight prophylactic apheresis platelet transfusions were administered to 46 patients undergoing high‐dose therapy followed by hematopoietic progenitor cell transplantation in a prospective, randomized, double‐blind, multiple‐crossover study. Transfusions were administered in pairs, differing only in platelet content. Each pair consisted of a lower‐dose platelet component (LDP) and a higher‐dose platelet component (HDP) administered in random order to the same patient. LDPs contained a mean of 3.1 × 10 11 platelets (range, 2.3‐3.5 × 10 11 ), and HDPs contained a mean of 5.0 × 10 11 platelets (range, 4.5‐6.1 × 10 11 ). Patients with active bleeding and those who were refractory to platelet transfusions were excluded. RESULTS: The mean posttransfusion platelet count increment with LDP was 17,010 per μL, and that with HDP was 31,057 per μL (p<0.0001). Only 37 percent of LDPs resulted in platelet count increments of at least 20,000 per μL, whereas 81 percent of HDPs resulted in increments above this level (p<0.0001). The mean transfusion‐free interval with LDP was 2.16 days, whereas that with HDP was 3.03 days (p<0.01). Administration of LDPs was associated with a 39 to 82 percent increase in the relative risk (per day) of requiring subsequent platelet transfusions (p<0.0001). CONCLUSION: As compared to the administration of HDPs, the administration of LDPs for prophylactic transfusion in hematopoietic progenitor cell transplant patients results in a lower platelet count increment, a lower likelihood of obtaining a posttransfusion platelet increment >20,000 per μL, a shorter transfusion‐free interval, and a greater relative risk per day of requiring additional transfusions.