By Anne McLeod, MD
2009-12-06
Transfusion medicine specialists are always striving to find ways to reduce the number of blood products used, and several studies being presented today and tomorrow in the Oral Sessions on Basic Science and Clinical Practice in Blood Transfusion (today and Monday at 4:30 p.m. in rooms 288-290 of the Ernest N. Morial Convention Center) will suggest new ways to achieve this goal.
Today at 4:45 p.m., Dr. Hannes Wandt from Nüremberg, Germany will present results of a multicenter randomized trial comparing the routine prophylactic transfusion of platelets (trigger: platelet count ≤ 109/L) with a strategy of transfusing platelets only in the presence of bleeding (abstract #20). Dr. Wandt and his colleagues found that although the duration of thrombocytopenia was significantly longer in the group not transfused prophylactically, this strategy resulted in a 25 percent decrease in platelet transfusions. However, bleeding complications were significantly higher in the group without prophylactic transfusions: five minor and two major cerebral hemorrhages occurred in the group without prophylactic transfusion, compared to none in the prophylactic transfusion arm. Both patients with major cerebral hemorrhage died. It is difficult to decide what cost is acceptable for the efficient use of blood products.
Also today, Dr.Darrell Triulzi from the Institute for Transfusion Medicine, Pittsburgh, will present results from the PLADO study (abstract #21). The PLADO study enrolled subjects with thrombocytopenia caused by stem cell transplantation (SCT) or chemotherapy and randomized them to receive either pooled platelets or apheresis platelets. In 1,272 patients who received a platelet transfusion, platelet characteristics including source (apheresis vs. pooled), duration of storage (three to five days), and ABO-matching status did not affect the outcome of time to the first grade 2 or higher bleeding event.
Today at 5:15 p.m. Annette Vetlesen, MT, from Oslo University will describe a new tool — HLA Class I Typing of Platelets by Multi-Color Flow Cytometry — and its potential for assessing survival, activation status, and activation capacity of transfused platelets versus autologous platelets, and for determination of stem cell engraftment after allogeneic SCT (abstract #22).
Of course, the best solution to prevent transfusion-related complications is avoiding transfusion altogether. Dr. Anargyros Xenocostas of the University of Western Ontario will present work (abstract #639) on Monday at 5:00 p.m. in the Basic Science and Clinical Practice in Blood Transfusion: Transfusion Medicine, Basic Science, and Laboratory Research Oral Session, showing that erythropoietin treatment was just as effective as red cell transfusion in reducing infarct size and improving cardiac function after acute myocardial infarction in anemic rats. The acute cardioprotective effects of the erythropoietin treatment occurred in the absence of any changes in hemoglobin concentration.
Dr. McLeod indicated no relevant conflicts of interest.
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