How do we treat? Clinical haemotherapy: platelet transfusion

Platelet transfusions play an important role in prevention or treatment of bleeding in patients with thrombocytopenia or severely impaired platelet function. In clinical haemotherapy a number of decisions are necessary, including choice of the type of platelet concentrate, transfusion trigger for prophylactic platelet transfusions and the dose of platelet transfusion. Usage of apheresis platelet concentrates and pooled whole blood-derived platelet concentrates varies greatly between countries and individual institutions. A clear advantage of apheresis concentrates can only be demonstrated in allosensitized patients with HLA- or HPA-antibodies who receive antigen-compatible apheresis platelet concentrates. We follow the recommendation to base the product choice mainly on availability and medical indication. Recent data on therapeutic instead of prophylactic transfusions require a new position-fixing on when platelet transfusions should be given. Given the attempt to optimize patient safety and to avoid life-threatening bleeding complications the available data still suggest using a prophylactic approach in routine settings outside of clinical trials for treatment of thrombocytopenia in the context of chemotherapy and impaired platelet production. Various studies addressed the effect of platelet dose in prophylactic transfusions in patients with hypoproliferative thrombocytopenia. We will review these studies and discuss implications for clinical practice. Some patients fail to achieve the appropriate platelet count increase after transfusion. This is still a challenging situation for clinicians and transfusion services. Approaches to identify the cause of platelet refractoriness as well as therapeutic algorithms will be proposed.