Wandt H, Schaefer-Eckart K, Frank M, Birkmann J, Wilhelm M
BMT-Unit, Hematology/Oncology, Klinikum Nürnberg Nord, Nürnberg, Germany.
Bone Marrow Transplant. 2006 Feb;37(4):387-92. doi: 10.1038/sj.bmt.1705246.
Prophylactic platelet transfusions are considered as standard in most hematology centers, but there is a long-standing controversy as to whether standard prophylactic platelet transfusions are necessary or whether this strategy could be replaced by a therapeutic transfusion strategy. In 106 consecutive cases of patients receiving 140 autologous peripheral blood stem cell transplantations, we used a therapeutic platelet transfusion protocol when patients were in a clinically stable condition. Platelet transfusions were only used when relevant bleeding occurred (more than petechial). Median duration of thrombocytopenia <20 x 10(9)/l and <10 x 10(9)/l was 6 and 3 days, which resulted in a total of 989 and 508 days, respectively. In only 26 out of 140 transplants (19%), we observed clinically relevant bleeding of minor or moderate severity. No severe or life-threatening bleeding was registered. The median and mean number of single donor platelet transfusions was one per transplant (range 0-18). One-third of all transplants, and 47% after high-dose melphalan could be performed without any platelet transfusion. Compared with a historical control group, we could reduce the number of platelet transfusions by one half. This therapeutic platelet transfusion strategy can be performed safely resulting in a considerable reduction in prophylactic platelet transfusions.
在大多数血液学中心，预防性血小板输注被视为标准做法，但对于标准预防性血小板输注是否必要，或者这种策略是否可以被治疗性输血策略所取代，长期以来一直存在争议。在106例连续接受140次自体外周血干细胞移植的患者中，当患者临床状况稳定时，我们采用了治疗性血小板输注方案。仅在发生相关出血（不仅仅是瘀点）时才使用血小板输注。血小板计数<20×10⁹/L和<10×10⁹/L的中位持续时间分别为6天和3天，分别导致总计989天和508天。在140次移植中，仅26次（19%）观察到轻度或中度严重程度的临床相关出血。未记录到严重或危及生命的出血。单次供体血小板输注的中位数和平均数为每次移植1次（范围0 - 18次）。所有移植的三分之一以及大剂量美法仑治疗后的47%可以在不进行任何血小板输注的情况下进行。与历史对照组相比，我们可以将血小板输注次数减少一半。这种治疗性血小板输注策略可以安全实施，从而显著减少预防性血小板输注。
