Department of Haematology, Faculty of Medicine and University Hospital "Dr. Jose Eleuterio Gonzalez ", Autonomous University of Nuevo Leon, Monterrey, Mexico.
Blood Transfus. 2021 Jan;19(1):37-44. doi: 10.2450/2020.0045-20. Epub 2020 Nov 3.
Platelet transfusion plays a critical role in the supportive treatment of acute leukaemia patients who receive chemotherapy and haematopoietic stem cell transplantation (HSCT). There are few studies assessing appropriateness of platelet transfusion in this population. An audit was conducted to determine how appropriately platelets are transfused in acute leukaemia patients at a tertiary care health institution.
A six-year retrospective audit was conducted in acute lymphoblastic (ALL) and acute myeloid leukaemia (AML) patients in an Academic Centre. Episodes were assessed as either appropriate or inappropriate based on guidelines from the British Society for Haematology (BSH). Pre-transfusion platelet count, transfusion indication, World Health Organization (WHO) bleeding score, and antibiotic use were all documented.
Overall, 745 platelet transfusion episodes in 154 patients were audited. The proportion of episodes appropriately indicated according to BSH guidelines was 75.3%. Paediatrics and Internal Medicine had the lowest and highest proportion of appropriateness by department at 63.9% and 86.8%, respectively. The best alignment to guidelines was found on the wards (82.3%). Inpatient cases were significantly better indicated (p=0.002), whereas therapeutic and HSCT-related transfusions were not. The majority of inappropriate transfusions had a pre-transfusion count >20×10/L without a valid justification (45.1%), whereas appropriate episodes were mainly accounted for by a pre-transfusion count <10×10/L (69%).
The 25% rate of inappropriate platelet transfusion in acute leukaemia patients underscores the learning needs of physicians, particularly those in training, regarding adequate use of platelets in haematologic malignancies to optimise its utilisation and patient outcome.
血小板输注在接受化疗和造血干细胞移植（HSCT）的急性白血病患者的支持性治疗中起着关键作用。很少有研究评估该人群中血小板输注的适宜性。进行了一项审计，以确定在一家三级保健机构中，急性白血病患者的血小板输注是否适宜。
在学术中心对急性淋巴细胞白血病（ALL）和急性髓系白血病（AML）患者进行了为期六年的回顾性审计。根据英国血液学学会（BSH）的指南，将病例评估为适当或不适当。记录了输注前血小板计数、输血指征、世界卫生组织（WHO）出血评分和抗生素使用情况。
共审计了 154 例患者的 745 例血小板输注病例。根据 BSH 指南，适当指示的病例比例为 75.3%。儿科和内科的适当性比例最低和最高，分别为 63.9%和 86.8%。与指南的最佳一致性是在病房中发现的（82.3%）。住院患者的指示明显更好（p=0.002），而治疗性和 HSCT 相关的输血则不然。大多数不适当的输血前计数>20×10/L 且没有有效依据（45.1%），而适当的病例主要是由于输血前计数<10×10/L（69%）。
急性白血病患者 25%的不适当血小板输注率突显了医生，特别是那些处于培训阶段的医生，在血液恶性肿瘤中充分利用血小板以优化其利用和患者结局方面的学习需求。
