Blood, Vol. 93 No. 9 (May 1), 1999:
pp. 3124-3126
A Restrictive Platelet Transfusion Policy Allowing Long-Term
Support of Outpatients With Severe Aplastic Anemia
Markus Sagmeister,
Lic Oec, and
Jürg Gmür
From the Department of Internal Medicine, the Division of Hematology,
University Hospital of Zürich, Zürich, Switzerland.
The threshold for prophylactic platelet transfusions in patients
with hypoplastic thrombopenia generally recommended in the standard
literature is 20,000 platelets/µL. A more restrictive transfusion
policy may be indicated in patients with chronic severe aplastic anemia
(SAA) in need of long-term platelet support. We evaluated the
feasibility and safety of a policy with low thresholds for prophylactic
transfusions (
5,000 platelets/µL in stable patients; 6,000 to
10,000 platelets/µL in cases with fever and/or hemorrhagic signs)
combined with progressive lengthening of transfusion intervals (up to
at least 7 days irrespective of the interim course of platelet counts).
The study was based on a retrospective analysis of a total of 18,706 patient days with platelet counts 10,000/µL in patients with
chronic SAA treated (for more than 3 months) on an outpatient basis.
Altogether, 1,135 platelet transfusions were given, 88% at counts
10,000/µL and 57% at counts 5,000/µL. The mean transfusion
interval was 10 days. During the period of observation, three major
nonlethal bleeding complications occurred, which could be well
controlled. We conclude that the restrictive policy with low
transfusion thresholds and prolonged transfusion intervals proved
feasible and safe in chronic SAA patients.
