Treatment
Leukoreduction
➤ UPDATED. The incidence of alloantibody-mediated refractoriness to
platelet transfusion can be decreased in patients with AML receiving
induction chemotherapy when both platelet and RBC products are
leukoreduced before transfusion. It is therefore appropriate to provide
leukoreduced blood products to patients with AML from the time of
diagnosis to ameliorate this important clinical problem. Although
randomized trials have not been conducted in other patient groups, it is
likely that alloimmunization can also be decreased in patients with other
types of leukemia and in other cancer patients receiving chemotherapy.
There are fewer data in patients who are not receiving chemotherapy
in the same time periods that the transfusions are being administered
(for example, aplastic anemia, myelodysplasia), although the consensus
would favor its use in these patients as well. In the US and several
other countries, the overwhelming majority of blood products are now
leukoreduced at the time of blood collection and component preparation.
Other advantages of prestorage leukoreduction include a substantial
reduction in transfusion reactions and transmission of cytomegalovirus
(CMV) infection. (Strong Recommendation; EB-H)
Prophylactic vs Therapeutic Platelet Transfusion
➤ Prophylactic platelet transfusion should be administered to patients with
thrombocytopenia resulting from impaired bone marrow function to reduce
the risk of hemorrhage when the platelet count falls below a predefined
threshold level. This threshold level for transfusion varies according to
the patient's diagnosis, clinical condition, and treatment modality. (Strong
Recommendation; EB-H)
Platelet Transfusion Threshold in Patients with Hematologic
Malignancies
➤ The Panel recommends a threshold of <10 x 10
9
/L for prophylactic platelet
transfusion in patients receiving therapy for hematologic malignancies.
Transfusion at higher levels may be advisable in patients with signs of
hemorrhage, high fever, hyperleukocytosis, rapid fall of platelet count, or
coagulation abnormalities (for example, acute promyelocytic leukemia)
and in those undergoing invasive procedures or in circumstances in which
platelet transfusions may not be readily available in case of emergencies,
as might be the case in outpatients who live at a distance from the
treatment center. (Strong Recommendation; EB-H)
