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). 

DOI Link

Purpose

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

TYPE OF STUDY: Systematic review

Search Strategy

DATABASES USED: MEDLINE, Embase, The Cochrane Library Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), UKBTS/SRI Transfusion Evidence Library, Literature in the Health Sciences in Latin America and the Caribbean (LILACS), KoreaMed, PakMediNet, IndMED, and the Conference Proceedings Citation Index (CPCI)
 
KEYWORDS: Platelets, transfusion, thrombocyte, prophylactic, hematologic, platelet transfusion, blood transfusion, hemorrhage, stem cell transplant, thrombocytopenia 
 
INCLUSION CRITERIA: Randomized controlled trials including patients of all ages undergoing stem cell transplants or patients with hematological diseases undergoing chemotherapy
 
EXCLUSION CRITERIA: Patients not being treated with myelosuppressive chemotherapy were excluded.

Literature Evaluated

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.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 13 
 
TOTAL PATIENTS INCLUDED IN REVIEW = 2,331 
 
KEY SAMPLE CHARACTERISTICS: Patients of all ages with hematological disorders receiving treatment with myelosuppressive chemotherapy and/or stem cell transplantation

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after active treatment
 
APPLICATIONS: Pediatrics, elder care

Results

This review looked at four different comparisons of prophylactic platelet trials. Three trials compared prophylactic platelet transfusion patients versus patients receiving therapeutic platelet transfusions. There was no statistical difference between the groups, but there was a wide confidence interval reported (0.9 to 3.04) indicating that there may be a need for more data. Three trials compared different platelet count thresholds to decide when to transfuse. No statistical difference was seen among the studies in clinical significant bleeding. In the next comparison, six studies examined using different doses of prophylactic platelets. The end result showed no evidence that using the lower dose of platelets caused increased bleeding, which led to using less of the platelet supply. The last comparison was a study comparing prophylactic platelet infusions versus platelet-poor plasma. This study showed the risk for bleeding in the prophylactic platelet arm was decreased significantly (RR 0.47; CI 0.23 to 0.95).

Conclusions

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.

Limitations

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.

Nursing Implications

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.

Legacy ID

4536