Callow, C.R., Swindell, R., Randall, W., & Chopra, R. (2002). The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy. British Journal of Haematology, 118, 677–682.

Prophylactic platelet transfusion policy

Comparison of platelet usage to nine months preceding intervention

• N = 98
• KEY DISEASE CHARACTERISTICS: Inpatients with hematologic malignancy; all had prolonged pancytopenia; some patients had undergone transplant

• Intervention trial that was nonexperimental, not randomized

• Protocol: less than 10–all, 10–20—bone marrow biopsy, pyrexia greater than 38, coagulation disorder, major bleed; 20–50—major bleed, soft tissue bleed, fresh retinal hem, disseminated intravascular coagulation (DIC), hemorrhagic cystitis; greater than 50—surgery
• Bleeding defined by World Health Organization (WHO) criteria (grade 0: no bleeding; grade 1: petechiae; grade 2: mild blood loss; grade 3: gross blood loss; grade 4: debilitating blood loss)
   

• Less than 10k—13 bleeds
• 10–20k—27 bleeds
• Greater than 20k—117 bleeds (18 DIC and 54 hemorrhagic cystitis); one death with DIC
• Transfusion trigger less than 10k in absence of fresh bleeding and sepsis is safe.
   

• Type of chemotherapy not controlled
• Fifty-four episodes of bleeding were hemorrhagic cystitis
• Bleeding episodes not separated by patient (one patient with 32 episodes)
• Platelet usage was compared, but bleeding was not.
• Rubella et al. (1997) with further support of 10k platelet level