Estcourt, L., Stanworth, S., Doree, C., Hopewell, S., Murphy, M.F., Tinmouth, A., & Heddle, N. (2012). Prophylactic platelet transfusion for prevention of bleeding in patients with haematological disorders after chemotherapy and stem cell transplantation. The Cochrane Database of Systematic Reviews, 2012(5).
STUDY PURPOSE: To determine the most effective use of platelet transfusion in order to prevent bleeding in hematologic patients receiving chemotherapy or stem cell transplantation
TOTAL REFERENCES RETRIEVED: 4,434 records screened
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two independent authors did the initial screening of all citations and abstracts. The third author was utilized for disagreements among reviewing authors. A study eligibility form was developed to assist with assessment of relevance. Data extraction was performed by two authors using guidelines by the Cochrane Collaboration. Using the Cochrane Handbook, two review authors assessed all studies for a possible risk of bias, which included information about the design, conduct, and analysis of trials.
PHASE OF CARE: Transition phase after active treatment
APPLICATIONS: Pediatrics, elder care
This review was intended to examine several questions looking at the endpoint objective of determining the best use of platelet transfusions for the prevention of bleeding in patients with hematological diseases receiving myelosuppressive chemotherapy or stem cell transplants. The review did not provide any new evidence for changing the current practice of prophylactic threshold of 10 x 109/L to prevent bleeding. The point of using a lower dose of platelets was identified and should be used in order to preserve the platelet supply as well as to prevent alloimmunization in patients. The findings of this review suggest the need for more studies.
Some of the studies were identified as having flaws in validity due to not describing methodology in the study. One study examined also had a small sample size.
Direct-care nurses are at the frontline in administrating these products and monitoring for bleeding and possible reactions. In many centers and hospitals, providers may be rotating through the service and may not realize the recommended threshold, thus exposing patients to unnecessary transfusions and usage of the current supply.