Schiffer C A, Anderson K C, Bennett C L, Bernstein S, Elting L S, Goldsmith M, Goldstein M, Hume H, McCullough J J, McIntyre R E, Powell B L, Rainey J M, Rowley S D, Rebulla P, Troner M B, Wagnon A H
Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit MI, USA.
J Clin Oncol. 2001 Mar 1;19(5):1519-38. doi: 10.1200/JCO.2001.19.5.1519.
To determine the most effective, evidence-based approach to the use of platelet transfusions in patients with cancer.
Outcomes of interest included prevention of morbidity and mortality from hemorrhage, effects on survival, quality of life, toxicity reduction, and cost-effectiveness.
A complete MedLine search was performed of the past 20 years of the medical literature. Keywords included platelet transfusion, alloimmunization, hemorrhage, threshold and thrombocytopenia. The search was broadened by articles from the bibliographies of selected articles.
Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly related to one of the primary outcomes in a randomized design. BENEFITS/HARMS/COST: The possible consequences of different approaches to the use of platelet transfusion were considered in evaluating a preference for one or another technique producing similar outcomes. Cost alone was not a determining factor.
Appendix A summarizes the recommendations concerning the choice of particular platelet preparations, the use of prophylactic platelet transfusions, indications for transfusion in selected clinical situations, and the diagnosis, prevention, and management of refractoriness to platelet transfusion.
Five outside reviewers, the ASCO Health Services Research Committee, and the ASCO Board reviewed this document.
American Society of Clinical Oncology
确定癌症患者使用血小板输注最有效、基于证据的方法。
关注的结果包括预防出血导致的发病和死亡、对生存的影响、生活质量、降低毒性以及成本效益。
对过去20年的医学文献进行了全面的医学文献数据库检索。关键词包括血小板输注、同种免疫、出血、阈值和血小板减少症。通过所选文章参考文献中的文章扩大检索范围。
证据水平和指南等级通过标准流程评定。对在随机设计中直接测试与主要结果之一相关假设的研究给予更大权重。益处/危害/成本：在评估对产生相似结果的一种或另一种技术的偏好时，考虑了血小板输注不同使用方法的可能后果。仅成本不是决定因素。
附录A总结了有关特定血小板制剂选择、预防性血小板输注的使用、特定临床情况下的输血指征以及血小板输注难治性的诊断、预防和管理的建议。
五名外部评审员、美国临床肿瘤学会卫生服务研究委员会和美国临床肿瘤学会董事会审查了本文件。
美国临床肿瘤学会
