Gil-Fernández J J, Alegre A, Fernández-Villalta M J, Pinilla I, Gómez García V, Martinez C, Tomás J F, Arranz R, Figuera A, Cámara R, Fernández-Rañada J M
Hematology and Hemotherapy Department, Hospital Universitario de la Princesa, Madrid, Spain.
Bone Marrow Transplant. 1996 Nov;18(5):931-5.
The threshold for prophylactic platelet transfusion remains controversial. Usually the decision is based on arbitrary numerical criteria. The classical 20 x 10(9)/l trigger could be safely reduced with considerable benefits. Few studies have evaluated the clinical impact of stringent policies. We have performed a retrospective analysis comparing major haemorrhages during hospitalization in 190 patients undergoing BMT in two different periods. In 87 patients transplanted from 1990 to 1991, the 20 x 10(9)/l trigger was used for prophylactic platelet transfusion. In 103 other patients transplanted from 1993 to 1994, we adopted a stringent prophylactic policy: < 10 x 10(9)/l for stable patients and < 20 x 10(9)/l when higher platelet consumption factors were present. In the stringent group, 12 patients presented 13 major haemorrhages and four died from haemorrhage. In the classical group 12 patients presented 14 major haemorrhages and three died from haemorrhage. Platelet consumption factors were present in 12 of 13 haemorrhages in the stringent group and in 12 of 14 in the classical group. By contrast, stable patients presented less haemorrhages (2/14 and 1/13, respectively). A statistically significant reduction in the use of platelet units was observed when comparing both groups: the median of platelet units administered in the first 100 days of transplant was 73 (3-943) and 54 (0-647) in the classical and in the stringent group, respectively (P < 0.01); and the median of platelet units received per day was 0.8 (0.03-30) and 0.5 (0-6.94) (P < 0.01). Our results emphasize the safety of a stringent prophylactic platelet transfusion policy after BMT, reducing the overall use of platelet transfusions. Further studies are necessary to confirm these results and to define optimal transfusion strategies.
预防性血小板输注的阈值仍存在争议。通常，这一决定是基于任意的数值标准。经典的20×10⁹/L触发值可以安全降低，且有显著益处。很少有研究评估严格政策的临床影响。我们进行了一项回顾性分析，比较了190例接受骨髓移植的患者在两个不同时期住院期间的大出血情况。在1990年至1991年接受移植的87例患者中，预防性血小板输注采用20×10⁹/L触发值。在1993年至1994年接受移植的另外103例患者中，我们采用了严格的预防性政策：稳定患者为<10×10⁹/L，当存在较高血小板消耗因素时为<20×10⁹/L。在严格组中，12例患者出现了13次大出血，4例死于出血。在经典组中，12例患者出现了14次大出血，3例死于出血。严格组13次大出血中有12次存在血小板消耗因素，经典组14次中有12次存在。相比之下，稳定患者的出血较少（分别为2/14和1/13）。比较两组时，观察到血小板单位使用量有统计学意义的减少：移植后前100天输注血小板单位的中位数在经典组和严格组分别为73（3 - 943）和54（0 - 647）（P < 0.01）；每天接受血小板单位的中位数为0.8（0.03 - 30）和0.5（0 - 6.94）（P < 0.01）。我们的结果强调了骨髓移植后严格的预防性血小板输注政策的安全性，减少了血小板输注的总体使用。需要进一步研究来证实这些结果并确定最佳输血策略。
