Diedrich, B., Remberger, M., Shanwell, A., Svahn, B.M., & Ringden, O. (2005). A prospective randomized trial of a prophylactic platelet transfusion trigger of 10 x 10⁹ per L versus 30 x 10⁹ per L in allogeneic hematopoietic progenitor cell transplant recipients. Transfusion, 45, 1064–1072. 

To compare differences in the number of platelet transfusions received and episodes of hemorrhagic bleeding, based upon a prophylactic transfusion trigger of either less than 10 x 10⁹ per L or less than 30 x 10⁹ per L, in patients undergoing allogeneic hematopoietic progenitor stem cell transplants

Patients were randomized (after stratification) to receive prophylactic platelet transfusions at either less than 10 x 10⁹ or less than 30 x 10⁹ per L. The number of transfusions received, the types of bleeding episodes, and the number of red blood cell transfusions were recorded 7 days pre- to 30 days post-transplantation. The results of the morning lab draws identified the need for transfusion based upon the trigger group (T 10 or T 30). In addition, patients were assessed daily (if inpatient) and twice weekly (if outpatient) by nurses blinded to the treatment arm. A special research nurse was used to collect study data. 

• N = 166  
• AGE RANGE = 1–63 years
• MALES: 52%, FEMALES: 48%
• KEY DISEASE CHARACTERISTICS: Patients undergoing transplants for non-malignant, acute, or chronic leukemia, or other solid tumor malignancy. Exclusion criteria included known bleeding disorders or coagulopathy.

• SITE: Single-site    
• SETTING TYPE: Inpatient    
• LOCATION: University Hospital in Sweden

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics

Prospective, randomized trial

• World Health Organization (WHO) criteria

There were no significant differences between the groups based upon donor type, origin of hematopoietic progenitor cells, age, or conditioning regime used. There was a significantly lower number of transfusions received in the T 10 group (median 4 versus 10, p < 0.001) without a significant difference in the episodes of bleeding between groups.

The evidence suggests that the trigger for prophylactic platelet transfusions in patients undergoing allogeneic hematopoietic progenitor stem cell transplants may be safely decreased from 30 x 10⁹ to 10 x 10⁹ per L.

Note that the logistic regression multivariate analysis of factors associated with platelet transfusions before day 30 and before day 60 demonstrate wide confidence intervals (95% CI, 3.08–18.7 and 95% CI 1.82–9.67, respectively).

Nurses will care for patients at risk of life threatening bleeding and need to be aware of indications for platelet transfusion. A lower threshold for prophylactic transfusion may conserve the blood supply.