The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy

被引:41
作者
Callow, CR [1 ]
Swindell, R [1 ]
Randall, W [1 ]
Chopra, R [1 ]
机构
[1] Christie Hosp NHS Trust, Dept Haematol Oncol, Manchester M20 4BX, Lancs, England
关键词
prophylactic platelet transfusion; haemorrhagic episodes; blood product usage; health care savings;
D O I
10.1046/j.1365-2141.2002.03616.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Indications for platelet transfusion remain controversial and are frequently based on arbitrary numerical criteria. In October 2000, we introduced a stringent prophylactic-platelet transfusion policy < 10 x 10(9) /l for stable patients and < 20 x 10(9) /l in the presence of major bleeding or additional risk factors. A trigger of < 50 x 10(9) /l was introduced for patients undergoing invasive procedures. A prospective analysis was performed measuring the frequency of minor and major bleeding events, morbidity, mortality and duration of pancytopenia. Blood product usage was assessed and health care savings measured. A total of 98 patients were evaluated on 2147 patient study days and 271 bleeding episodes were recorded. Major bleeding occurred on 1.39% (30/2147) of the study days when platelet counts were < 10 x 10(9) /l and 2.3% (50/2147) of the study days when platelet counts were 10-20 x 10(9) /l. In patients with platelets > 20 x 10(9) /l, there were 117 major bleeding episodes observed on 5.4% of the study days. In patients with no identified additional risk factors present, major haemorrhages were recorded in 0.51% (11/2147) of the study days in patients with platelet counts greater than or equal to 10 x 10(9) /l. There was a 36% reduction in platelet units transfused compared with retrospective data when an arbitrary transfusion trigger of 20 x 10(9) /l was in place (P = < 0.02). Of note, a 16% reduction in red cell transfusions was recorded. These data confirm that the introduction of a transfusion trigger of < 10 x 10(9) /l in the absence of fresh bleeding and sepsis (> 38degreesC) is safe and has a significant impact on overall hospital transfusion costs.
引用
收藏
页码:677 / 682
页数:6
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