Platelet transfusion dose did not affect bleeding in hypoproliferative thrombocytopenia

The use of low-dose platelet transfusion in patients undergoing hematopoietic stem-cell transplantation with platelet counts less than 10,000/mm³ did not significantly affect bleeding compared with higher doses and resulted in a decreased number of platelets transfused per patient.

A low-dose strategy “significantly reduces the quantity of platelets transfused, which could preserve these scare blood components but could also increase the number of platelets transfusions,” researchers wrote in a recently published study.

The results were previously presented at the 50th ASH Annual Meeting.

In the study, the researchers randomly assigned patients with hypoproliferative thrombocytopenia to one of three levels of platelet transfusion: low-dose, 1.1310¹¹; medium dose, 2.2310¹¹; or high dose, 4.4310¹¹ platelets/m². The primary endpoint was grade-2 or higher bleeding.

“The percentage of bleeding of grade-2 or higher was significantly less among those undergoing autologous or syngeneic hematopoietic stem-cell transplantation (57%) than among those with hematologic cancers who were undergoing chemotherapy (73%) or those undergoing allogeneic hematopoietic stem-cell transplantation (79%),” the researchers wrote.

After randomization, 1,272 patients underwent at least one platelet transfusion. Rates of grade-2 or higher bleeding were similar among the three groups: low dose, 71%; medium dose, 68%; high dose, 70%.

Patients assigned to a low-dose transfusion had a median of 9.25310¹¹ platelets transfused vs. 11.25310¹¹ in the medium-dose group and 19.63310¹¹ in the high-dose group (P =.002 for low dose vs. medium dose; P<.001 for high dose vs. low dose and high dose vs. medium dose).

However, those patients in the low-dose group underwent a median of five transfusions compared with three in the medium- and high-dose groups.

Slichter SJ. N Engl J Med. 2010;362:600-613.

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