Thrombocytopenia and Platelet Transfusion
Murphy MF., Stanworth S., Estcourt L.
A variety of diverse congenital and acquired conditions are associated with thrombocytopenia, and acquired thrombocytopenia is relatively common. Thrombocytopenia associated with the administration of chemotherapy or with surgical procedures are the most frequent indications for platelet transfusion. A prophylactic platelet transfusion threshold of 10 x 109/L is generally accepted for patients receiving cancer chemotherapy. Maintenance of a higher platelet count is indicated in a number of situations, including the settings of sepsis, DIC, hemorrhage, trauma, and surgery. Febrile and allergic reactions to platelet transfusion can often be managed conservatively with the administration of acetaminophen and diphenhydramine. Platelet refractoriness caused by nonimmune and immune mechanisms remains a major issue when repeated transfusions are required. HLA matching and platelet crossmatching are initial strategies to address immune platelet refractoriness. Antifibrinolytic agents may be useful adjuncts to platelet transfusion in the bleeding or platelet refractory patient. Because of the limitations of current storage techniques, research and development continue on platelet storage and substitutes. Thrombopoiesis-stimulating agents should provide additional therapeutic alternatives for the management of thrombocytopenia in specific settings. However, much additional research will be necessary in order to establish their safety and efficacy in patients receiving cancer chemotherapy.