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Blood, Vol. 92 No. 4 (August 15), 1998:
pp. 1448-1453
Platelet Transfusion: A Dose-Response Study
Françoise Norol,
Philippe Bierling,
Françoise Roudot-Thoraval,
Françoise Ferrer Le Coeur,
Claire Rieux,
Anne Lavaux,
Mathieu Kuentz, and
Najib Duedari
From ETS Sud-Est Francilien, Hôpital Henri Mondor, Creteil;
Unité Evaluation Etude, Hôpital Henri Mondor, Creteil;
Service d'Hématologie, Hôpital Henri Mondor, Creteil; and
Unité de Médecine Transfusionnelle et
d'Hémovigilance, Hôpital Henri Mondor, Creteil, France.
Early recommendations on prophylactic transfusion of
thrombocytopenic patients involved a standard platelet dose of about 0.5 × 1011/10 kg body weight. Given the lack of data
supporting this dose, we prospectively studied the dose response to
platelet transfusions in adults and children with hematologic
malignancies. Each patient received, in similar clinical conditions, a
medium, high, and very high dose of fresh (< 24 hours old)
ABO-compatible platelets, in the form of apheresis platelet
concentrates (APC). For the adults, the medium dose was defined as APC
containing between 4 and 6 × 1011 platelets, the high
dose between 6 and 8 × 1011, and the very high dose > 8 × 1011; for the children, the three doses corresponded to
2 to 4, 4 to 6, and > 6 × 1011 platelets. The end
points were the platelet increment, platelet recovery, and the
transfusion interval, and the results were compared with a paired
t-test. Sixty-nine adults and 13 children could be assessed. Recoveries
in the adults were similar with the three doses (from 28% to 30%),
but the high and very high doses led to a significantly better platelet
increment (52 and 61 × 109/L, respectively) than the
medium dose (33 × 109/L, P < .01). The main
difference was in the transfusion interval, which increased with the
dose of platelets transfused, from 2.6 days with the medium dose to 3.3 and 4.1 days with the high and very high doses, respectively (P < .01). The positive effect of the high dose was observed regardless
of pretransfusional clinical status, but was more marked in patients
with no clinical factors known to impair platelet recovery. In these
patients, a platelet dose of 0.07 × 1011 per kg of body
weight led to a transfusion interval of more than 2 days in 95% of
cases. In patients with clinical factors favoring platelet consumption,
the proportion of transfusions yielding an optimal platelet increment
and transfusion interval increased with the dose of platelets.
The platelet dose-effect was also significant in the children, in
whom the high and very high doses led to 1.5-fold to twofold higher
posttransfusion platelet counts and transfusion intervals. We conclude
that transfusion of high platelet doses can reduce the number of
platelet concentrates required by thrombocytopenic patients and
significantly reduce donor exposure.
© 1998 by The American Society of Hematology.
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