The influence of bleeding on trigger changes for platelet transfusion in patients with chemotherapy-induced thrombocytopenia

• Published in: Transfusion (Philadelphia, Pa.) Vol. 53; no. 2; pp. 306 - 314
• Main Authors: Rioux-Massé, Benjamin, Laroche, Vincent, Bowman, Robert J., Lindgren, Bruce R., Cohn, Claudia S., Pulkrabek, Shelley M., McCullough, Jeffrey
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-02-2013; Wiley; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Agents - adverse effects; Biological and medical sciences; Blood coagulation. Blood cells; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; Female; Fundamental and applied biological sciences. Psychology; Hemorrhage - blood; Hemorrhage - complications; Hemorrhage - etiology; Hemorrhage - therapy; Humans; Male; Medical sciences; Middle Aged; Molecular and cellular biology; Platelet; Platelet Transfusion - methods; Prognosis; Severity of Illness Index; Thrombocytopenia - blood; Thrombocytopenia - complications; Thrombocytopenia - diagnosis; Thrombocytopenia - therapy; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Treatment Outcome; Young Adult; Human; Thrombocytopenia; Chemotherapy; Platelet; Treatment; Transfusion; Hemopathy; Hemorrhage
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/j.1537-2995.2012.03727.x

BACKGROUND: For patients with thrombocytopenia without bleeding risk factors, a platelet transfusion trigger of 10 × 109/L is recommended. No studies have evaluated the clinicians' decision‐making process leading to trigger changes.
STUDY DESIGN AND METHODS: We report on the evaluation of trigger changes and the relation with bleeding. Eighty patients previously enrolled in the SPRINT trial represent the patient population for the current analysis.
RESULTS: Seventy‐four patients had a starting trigger of 10 × 109/L. Only a minority of patients treated with chemotherapy alone (3/12, 25%) and autologous transplant (6/15, 40%) had a change in their trigger in contrast to the majority of allogeneic transplant (37/47, 79%; p = 0.001 and p = 0.009, respectively, when compared to allogeneic transplant group). Bleeding was the main reason reported by clinicians for a trigger change, but the occurrence of significant bleeding (Grade 2‐4) was similar in patients with or without a trigger change (51 and 54%, p = 1.00). Clinicians were influenced by the bleeding system: Grade 1 mucocutaneous bleeding leading to a trigger change was overrepresented (71% of cases), as was Grade 2 genitourinary bleeding not leading to a trigger change (57% of cases).
CONCLUSION: A universal trigger of 10 × 109/L may not be maintained in a diverse population of patients with their respective bleeding risk factors. Because the trigger is changed often, it may not be as effective as previously believed.