Platelet transfusion for patients with platelet dysfunction: effectiveness, mechanisms, and unanswered questions

• Published in: Current opinion in hematology Vol. 27; no. 6; pp. 378 - 385
• Main Authors: Lee, Robert H., Kasthuri, Raj S., Bergmeier, Wolfgang
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-11-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• ISSN: 1065-6251; 1531-7048
• DOI: 10.1097/MOH.0000000000000608

PURPOSE OF REVIEWIn this review, we discuss current clinical guidelines and potential underlying mechanisms regarding platelet transfusion therapy in patients at risk of bleeding, comparing management of patients with thrombocytopenia versus those with qualitative platelet disorders.
RECENT FINDINGSPlatelet transfusion therapy is highly effective in managing bleeding in patients with hypoproliferative thrombocytopenia. Clinical trials have demonstrated that platelet transfusion can be used at a lower trigger threshold and reduced platelet doses, and may be used therapeutically rather than prophylactically in some situations, although additional data are needed. In patients with inherited platelet disorders such as Glanzmannʼs Thrombasthenia or those with RASGRP2 mutations, platelet transfusion may be ineffective because of competition between transfused and endogenous platelets at the site of vascular injury. Successful management of these patients may require transfusion of additional platelet units, or mechanism-driven combination therapy with other pro-hemostatic agents. In patients on antiplatelet therapy, timing of transfusion and inhibitor mechanism-of-action are key in determining therapeutic success.
SUMMARYExpanding our understanding of the mechanisms by which transfused platelets exert their pro-hemostatic function in various bleeding disorders will improve the appropriate use of platelet transfusion.