Interventions to reduce platelet prophylactic transfusions in patients with hypoproliferative thrombocytopenia: providing patients with the full benefit.

To reduce the infectious and immunologic complications of platelet transfusions in patients with hypoproliferative thrombocytopenia, three interventions have aimed to decrease the number of prophylactic platelet transfusions received by such patients for the prevention of bleeding. These are the reduction of the platelet count threshold triggering prophylactic transfusion, the administration of low-dose (as opposed to standard-dose) platelet transfusions, and the administration of therapeutic (as opposed to prophylactic) platelet transfusions. We demonstrate that--in terms of absolute risk reduction in all infectious and some immunologic complications of transfusion--patients can benefit more from the transition to all-apheresis platelet supply than from the reduction of the platelet count threshold from 20,000/microL to 10,000/microL (mean reduction in the number of donor exposures by 26.28 versus 9.6, respectively). Also, patients can benefit just as much from the transition to an all-apheresis platelet supply as from the transition to a new standard of care employing therapeutic platelet transfusions for selected patients with hypoproliferative thrombocytopenia (mean reduction in the number of donor exposures by 4.08 versus 3.24, respectively). Finally, policies of low-dose platelet transfusions can directly benefit patients with hypoproliferative thrombocytopenia, effecting a median reduction in the number of donor exposures by 12.5 compared with a setting transfusing platelet pools, only if they are combined with Patient Blood Management (PBM) and an all-apheresis platelet supply. Thus, whatever strategy is adopted from among these three interventions, the replacement of the current platelet pools with an all-apheresis platelet supply is necessary for providing patients with the full benefit.