Heckman, K.D., Weiner, G.J., Davis, C.S., Strauss, R.G., Jones, M.P., & Burns, C.P. (1997). Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL. Journal of Clinical Oncology, 15, 1143–1149.

To compare two common prophylactic platelet transfusion thresholds for patients receiving induction chemotherapy for acute leukemia

Patients were divided into four groups: new diagnosis of leukemia in patients aged less than 60 years; new diagnosis in patients 60 years or greater; relapsed disease in patients aged less than 60 years; and relapsed disease in patients aged 60 years or greater. Patients were randomized by selecting cards from an envelope to receive platelets when their morning platelet counts were either 10,000 microliters or 20,000 microliters. All platelet apheresis product transfusions were given according to the same transfusion orders. Controls for failure to respond to platelet transfusion for all participants were included in the study as well as guidelines for removing patients if warranted. For serious and life threatening bleeding, and as otherwise directed by the treating physician, therapeutic platelets were administered to study participants.

• N = 78  
• AGE RANGE = 19–82 years
• MALES: 64%, FEMALES: 36%
• KEY DISEASE CHARACTERISTICS: Patients were treated with one of three commonly used induction therapies. These included cytarabine x 7 days and daunorubicin x 3 days; cytarabine 2–3 Gm/m2 every 12 hours x 12 doses; or mitoxantrone 12 mg/m2 x 3 days with etoposide 150 mg/m2 CI x 5 days. 
• OTHER KEY SAMPLE CHARACTERISTICS: None

• SITE: Single-site    
• SETTING TYPE: Inpatient    
• LOCATION: University of Iowa Hospital

• PHASE OF CARE: Active antitumor treatment
• APPLICATIONS: Pediatrics, elder care, and palliative care 

Prospective, randomized trial

• Bleeding toxicity scale
• Number of bleeding episodes (calculated by documentation in patient chart or observation by investigator) 

The study found that there was no statistical difference in the total number of bleeding episodes between the two groups of patients (p = .12). Of note, there was a significant increase in platelet reactions in the platelet group receiving ≤ 20,000 microliters (p = 0.005).

Administration of prophylactic platelets at a threshold of 10,000 microliters can cut back the utilization of platelets and reduce the incidence of viral exposure without a statistically significant effect on morbidity.

• Small sample (< 100)
• Risk of bias (no control group)
• Findings not generalizable

Nurses need to be familiar with professional guidelines and institutional policies regarding platelet transfusions. This would include the use of premedications, post-transfusion blood drawing, and reporting of platelet reactions. For those institutions that use platelet thresholds higher than 10,000 microliters, it may be time to revisit practice based on the findings of this study.