Platelet transfusion is a critical and often necessary aspect of managing cancer. Low platelet counts frequently lead to bleeding complications; however, the drugs used to combat malignancy commonly lead to decreased production and destruction of the very cell whose function is essential to stop bleeding. The transfusion of allogeneic platelet products helps to promote hemostasis, but alloimmunization may make it difficult to manage other complications associated with cancer.
Methods
The literature relating to platelet transfusion in patients with cancer was reviewed.
Results
Platelet storage, dosing, transfusion indications, and transfusion response are essential topics for health care professionals to understand because many patients with cancer will require platelet transfusions during the course of treatment. The workup and differentiation of non-immune-mediated compared with immune-mediated platelet refractoriness are vital because platelet management is different between types of refractoriness.
Conclusions
A combination of appropriate utilization of platelet inventory and laboratory testing coupled with communication between those caring for patients with cancer and those providing blood products is essential for effective patient care.
References
1.
American Association of Blood Banks (AABB).Circular of Information For the Use of Human Blood and Blood Components.Bethesda, MD: AABB; 2013. http://www.aabb.org/tm/coi/Documents/coi1113.pdf. Accessed November 16, 2014.
KaufmanR.M., DjulbegovicB., GernsheimerT.. Platelet transfusion: a clinical practice guideline from the AABB.Ann Intern Med.2014. [Epub ahead of print].
13.
StanworthS.J., EstcourtL.J., LlewelynC.A.. Impact of prophylactic platelet transfusions on bleeding events in patients with hematologic malignancies: a subgroup analysis of a randomized trial.Transfusion.2014; 54(10): 2385–2393.
14.
SchifferC.A.. They took a mulligan and mostly got it right…the issue of prophylactic platelet transfusion for patients receiving autologous stem cell transplantation.Transfusion.2014; 54(10): 2372–2374.
15.
KonkleB.A.. Acquired disorders of platelet function.Hematology Am Soc Hematol Educ Program.2011; 2011(1): 391–396.
16.
TriulziD.J., AssmannS.F., StraussR.G.. The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia.Blood.2012; 119(23): 5553–5562.
17.
SlichterS.J., DavisK., EnrightH.. Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients.Blood.2005; 105(10): 4106–4114.
18.
The Trial to Reduce Alloimmunization to Platelets Study Group.Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions.N Engl J Med.1997; 337(26): 1861–1869.
19.
DavisK.B., SlichterS.J., CorashL.. Corrected count increment and percent platelet recovery as measures of posttransfusion platelet response: problems and a solution.Transfusion.1999; 39(6): 586–592.
AsterR.H.. Pooling of platelets in the spleen: role in the pathogenesis of “hypersplenic” thrombocytopenia.J Clin Invest.1966; 45(5): 645–657.
22.
BolgianoD.C., LarsonE., SlichterS.J.. A model to determine required pool size for HLA-typed community donor apheresis programs.Transfusion.1989; 29(4): 306–310.
23.
SalamaO.S., AladlD.A., El GhannamD.M.. Evaluation of platelet cross-matching in the management of patients refractory to platelet transfusions.Blood Transfus.2014; 12(2): 187–194.
24.
VassalloR.R., FungM., RebullaP.; International Collaboration for Guideline Development, Implementation and Evaluation for Transfusion Therapies. Utility of cross-matched platelet transfusions in patient with hypoproliferative thrombocytopenia: a systematic review.Transfusion.2014; 54(4): 1180–1191.
PetzL.D., GarrattyG., CalhounL.. Selecting donors of platelets for refractory patients on the basis of HLA antibody specificity.Transfusion.2000; 40(12): 1446–1456.
27.
Fontão-WendelR., SilvaL.C., SavioloC.B.R.. Incidence of transfusion-induced platelet-reactive antibodies evaluated by specific assays for the detection of human leucocyte antigen and human platelet antigen antibodies.Vox Sanguinis.2007; 93(3): 241–249.
28.
Delaflor-WeissE., MintzP.D.. The evaluation and management of platelet refractoriness and alloimmunization.Transfus Med Rev.2000; 14(2): 180–196.
29.
DesmondR., TownsleyD.M., DumitriuB.. Eltrombopag restores trilineage hematopoiesis in refractory severe aplastic anemia that can be sustained on discontinuation of drug.Blood.2014; 123(12): 1818–1825.
