Korean J Lab Med.  2009 Apr;29(2):158-162. 10.3343/kjlm.2009.29.2.158.

Reduction of the Platelet Transfusion Dose and Its Effects

• Baek EJ
• Lee YS
• Kim HS
• Bae IC
• Kim HO

• KMID: 854977
• DOI: http://doi.org/10.3343/kjlm.2009.29.2.158

Abstract

BACKGROUND
In Korea, a platelet transfusion dose (TD) of 8 units of platelet concentrates (PC) is usually used. To minimize the shortage of blood products and transfusion-related adverse reactions, the TD has been changed from 8 to 6 units in 2006 in our hospital. Here, we analyzed the dose reduction effect on patients' platelet counts and transfusion frequency. METHODS: We compared the amount of issued PC, platelet counts before and after transfusion, post-transfusion platelet increments, and transfusion frequencies in patients who were transfused with 8 PC in 2006 and 6 PC in 2008. RESULTS: Despite an increase in the number of admitted patients by 20% in 2008 with a disease distribution similar to that in 2006, the number of issued PC in 2008 was decreased by 26.6% compared to that in 2006. In 2008, post-transfusion platelet counts, pre-transfusion platelet counts in patients transfused with 320 mL whole blood-derived PC, and platelet increments in patients transfused with 400 mL whole blood-derived PC were significantly decreased. However, the mean transfusion frequency per one month was not significantly different, 4.3 times in 2006 and 4.7 in 2008. CONCLUSIONS: By implementing a policy of platelet TD restriction, the amount of total issued PC was markedly decreased. Although post-transfusion platelet counts were decreased, the transfusion frequency in a month was not significantly increased. The restriction of platelet TD was helpful for increasing physicians' recognition of blood shortage while achieving similar transfusion effects. We conclude that 6 units of PC would be a better guideline for the platelet TD.

Keyword

Platelet; Transfusion dose; Adequate transfusion; Transfusion guidelines

MeSH Terms

Evaluation Studies as Topic
Humans
Organizational Policy
Platelet Count
*Platelet Transfusion

Figure

• 

  Fig. 1. The amount of platelet concentrates issued before and after reduction of the platelet transfusion dose.

Reference

1.Baek EJ., Kim HO., Kim S., ParK QE., Oh DJ. The trends of nationwide blood collection and the supply of blood in Korea during 2002-2006. Korean J Blood Transfus. 2008. 19:83–90. (백은정, 김현옥, 김신영, 박규은, 오덕자. 국내 헌혈 및 혈액공급의 변화(2002-2006년). 대한수혈학회지 2008;19: 83-90.).

2.Stanworth SJ., Hyde C., Brunskill S., Murphy MF. Platelet transfusion prophylaxis for patients with haematological malignancies: where to now? Br J Haematol. 2005. 131:588–95.

3.Han KS, Park MH, editors. Transfusion medicine. 3rd ed.Seoul: Korea Medicine;2006. p. 53. (한규섭, 박명희 등. 수혈의학. 제3판. 서울: 고려의학,. 2006:p. 53. ).

4.Tinmouth A., Tannock IF., Crump M., Tomlinson G., Brandwein J., Minden M, et al. Low-dose prophylactic platelet transfusions in recipients of an autologous peripheral blood progenitor cell transplant and patients with acute leukemia: a randomized controlled trial with a sequential Bayesian design. Transfusion. 2004. 44:1711–9.

5.Klumpp TR., Herman JH., Gaughan JP., Russo RR., Christman RA., Goldberg SL, et al. Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double-blind trial. Transfusion. 1999. 39:674–81.

6.Kim HO. Establishment of administrating organization for blood collection and utilization. Seoul: Korea centers for disease control and prevention. 2007. 59. (김현옥. 수혈관리체계기반구축을위한연구. 서울:질병관리본부,. 2007:59. ).

7.Brecher ME, editor. Technical manual. 15th ed.Bethesda: American Association of Blood Banks;2005. p. 490–1.

8.Rebulla P., Finazzi G., Marangoni F., Avvisati G., Gugliotta L., Tognoni G, et al. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto. N Engl J Med. 1997. 337:1870–5.

9.Schiffer CA., Anderson KC., Bennett CL., Bernstein S., Elting LS., Goldsmith M, et al. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001. 19:1519–38.

10.Heckman KD., Weiner GJ., Davis CS., Strauss RG., Jones MP., Burns CP. Randomized study of prophylactic platelet transfusion threshold during induction therapy for adult acute leukemia: 10,000/microL versus 20,000/microL. J Clin Oncol. 1997. 15:1143–9.

11.Qureshi H., Lowe D., Dobson P., Grant-Casey J., Parris E., Dalton D, et al. National comparative audit of the use of platelet transfusions in the UK. Transfus Clin Biol. 2007. 14:509–13.

12.British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol. 2003. 122:10–23.