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Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit.

Habr B, Charpentier J, Champigneulle B, Dechartres A, Daviaud F, Geri G, Cariou A, Chiche JD, Mira JP, Pène F - Ann Intensive Care (2015)

Bottom Line: However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding.The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.

View Article: PubMed Central - PubMed

Affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. bassem.habr@gmail.com.

ABSTRACT

Background: Thrombocytopenia is a frequent finding in critically ill cancer patients for whom indications of platelet transfusions are unclear. We herein addressed the current practices in platelet transfusion and the risk of bleeding in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit (ICU).

Methods: A retrospective monocenter study over a 7-year period was conducted in a medical ICU. Adult patients with malignancies and hypoproliferative thrombocytopenia, and who received at least one platelet concentrate during their ICU stay, were included.

Results: 296 patients were included and received a total of 904 platelet transfusions, for prophylactic indications in 300 (33.2 %) episodes, for securing an invasive procedure in 257 (28.4 %), and for treatment of minor to major bleeding manifestations in 347 (38.4 %). Most prophylactic transfusions (80 %) were performed at platelet count thresholds below 10-20 × 10(9)/L. Platelet increments were generally low in all three indications, 10 (interquartile range 2-25), 11 (2-25), and 8 (0-21) × 10(9)/L, respectively. A total of 97 major ICU-acquired bleeding events occurred in 40 patients. About half of those bleeding episodes (54.7 %) occurred at platelet counts below 20 × 10(9)/L. However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding. The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).

Conclusions: Most prophylactic platelet transfusions were given using thresholds of 10-20 × 10(9)/L in critically ill thrombocytopenic cancer patients. The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.

No MeSH data available.


Related in: MedlinePlus

Platelet count recovery according to indications for platelet transfusions
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Fig2: Platelet count recovery according to indications for platelet transfusions

Mentions: Indications for the 904 platelet transfusions were distributed into prophylactic in 300 (33.2 %) episodes, securing an invasive procedure in 257 (28.4 %) episodes, mainly for catheter insertion (42.3 %) and surgery (27 %), and therapeutic for minor to major bleeding manifestations in 347 (38.4 %) episodes. Grade 1, 2, 3, and 4 bleeding events accounted for 12, 135, 132, and 68 episodes of therapeutic platelet transfusions, respectively. Figure 1 represents the distribution of platelet transfusions according to pre-transfusion platelet count in those three indications. Most prophylactic transfusions (80 %) were performed when platelet counts were below 20 × 109/L. Figure 2 displays platelet recovery as estimated by pre- and post-transfusion platelet counts and the resulting platelet count increment in the three indications of platelet transfusions. Platelet transfusions were generally well tolerated as only five serious adverse events were reported, all being immediate respiratory deterioration presumably related to volume overload.Fig. 1


Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit.

Habr B, Charpentier J, Champigneulle B, Dechartres A, Daviaud F, Geri G, Cariou A, Chiche JD, Mira JP, Pène F - Ann Intensive Care (2015)

Platelet count recovery according to indications for platelet transfusions
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666191&req=5

Fig2: Platelet count recovery according to indications for platelet transfusions
Mentions: Indications for the 904 platelet transfusions were distributed into prophylactic in 300 (33.2 %) episodes, securing an invasive procedure in 257 (28.4 %) episodes, mainly for catheter insertion (42.3 %) and surgery (27 %), and therapeutic for minor to major bleeding manifestations in 347 (38.4 %) episodes. Grade 1, 2, 3, and 4 bleeding events accounted for 12, 135, 132, and 68 episodes of therapeutic platelet transfusions, respectively. Figure 1 represents the distribution of platelet transfusions according to pre-transfusion platelet count in those three indications. Most prophylactic transfusions (80 %) were performed when platelet counts were below 20 × 109/L. Figure 2 displays platelet recovery as estimated by pre- and post-transfusion platelet counts and the resulting platelet count increment in the three indications of platelet transfusions. Platelet transfusions were generally well tolerated as only five serious adverse events were reported, all being immediate respiratory deterioration presumably related to volume overload.Fig. 1

Bottom Line: However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding.The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.

View Article: PubMed Central - PubMed

Affiliation: Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. bassem.habr@gmail.com.

ABSTRACT

Background: Thrombocytopenia is a frequent finding in critically ill cancer patients for whom indications of platelet transfusions are unclear. We herein addressed the current practices in platelet transfusion and the risk of bleeding in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit (ICU).

Methods: A retrospective monocenter study over a 7-year period was conducted in a medical ICU. Adult patients with malignancies and hypoproliferative thrombocytopenia, and who received at least one platelet concentrate during their ICU stay, were included.

Results: 296 patients were included and received a total of 904 platelet transfusions, for prophylactic indications in 300 (33.2 %) episodes, for securing an invasive procedure in 257 (28.4 %), and for treatment of minor to major bleeding manifestations in 347 (38.4 %). Most prophylactic transfusions (80 %) were performed at platelet count thresholds below 10-20 × 10(9)/L. Platelet increments were generally low in all three indications, 10 (interquartile range 2-25), 11 (2-25), and 8 (0-21) × 10(9)/L, respectively. A total of 97 major ICU-acquired bleeding events occurred in 40 patients. About half of those bleeding episodes (54.7 %) occurred at platelet counts below 20 × 10(9)/L. However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding. The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).

Conclusions: Most prophylactic platelet transfusions were given using thresholds of 10-20 × 10(9)/L in critically ill thrombocytopenic cancer patients. The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.

No MeSH data available.


Related in: MedlinePlus