Therapeutic-only versus prophylactic platelet transfusion po | Figure 1

%27%3e%3cg%20id=%27Group-14%27%20transform=%27translate(13.000000,%20103.176124)%27%3e%3cg%20id=%27Group-Copy-5%27%20transform=%27translate(0.000000,%20182.676124)%27%3e%3crect%20id=%27Rectangle-8%27%20fill=%27%23E2E0DE%27%20x=%270%27%20y=%270%27%20width=%2736%27%20height=%2736%27%20rx=%2718%27%3e%3c/rect%3e%3cpath%20d=%27M28,27.6503435%20C28,22.127496%2023.5228474,17.6503435%2018,17.6503435%20C12.4771525,17.6503435%208,22.127496%208,27.6503435%20M18,16.3472505%20C20.8165136,16.3472505%2023.099749,14.0640151%2023.099749,11.2475015%20C23.099749,8.43098783%2020.8165136,6.1477524%2018,6.1477524%20C15.1834863,6.1477524%2012.9002509,8.43098783%2012.9002509,11.2475015%20C12.9002509,14.0640151%2015.1834863,16.3472505%2018,16.3472505%20Z%27%20id=%27Combined-Shape%27%20fill=%27%23FFFFFF%27%20fill-rule=%27nonzero%27%3e%3c/path%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/g%3e%3c/svg%3e)

Deleted account

Some actions are only available when you log in.

Report case

Report this to our moderators

Therapeutic-only versus prophylactic platelet transfusion policy in bone marrow disorders

You can view up to 4 cases without signing up Sign up for unlimited access

Cochrane Review; one study was eligible for inclusion in the review. This study was stopped after recruiting only nine participants because it had taken three years to recruit the nine participants (the study had planned to recruit 60 participants in two years). No ongoing studies were found.

Background:

In people with bone marrow disorders bleeding can be a problem due to a low platelet count, or because the platelets do not work properly, or both. Platelet transfusions can be given when bleeding occurs in order to stop the bleeding, or before bleeding occurs in order to prevent it.

It is currently unclear if the best transfusion policy is to give platelet transfusions only when bleeding occurs or to give them to prevent bleeding.

Conclusion

No evidence is available to help decide whether giving platelet transfusions to treat bleeding is as good as giving platelet transfusions when the platelet count is below a prespecified level. There is an urgent need for good-quality studies to answer the questions of this review.

Read the full Cochrane Review here

Comment

Sign up to add a comment

More about this case

ResolvedVerified literature

Why you should join Figure 1

Sign up to explore now

Similar cases

\ \ Background\ Erythropoietin is a hormone produced by the kidneys. It stimulates the bone marrow to produce more red blood cells (RBCs). Erythropoietin is frequently used to correct anaemia caused by a reduced number of red blood cells or low haemoglobin concentration in cases of chronic renal failure. The haemoglobin in red blood cells carries oxygen around the body.\ Adult patients undergoing non‐cardiac surgery, such as bone (orthopaedic) surgery, have blood tests before surgery to check their general health. Many individuals are found to be anaemic, which means they may need RBC transfusions with donor blood before, during, or after surgery to increase their haemoglobin concentrations. Giving donor blood can cause an allergic reaction such as a rash, headache, fever, raised blood pressure, temporary loss of kidney function, and blood clotting. If it is possible to diagnose the cause of the anaemia before the operation, then erythropoietin can be used together with iron to treat most of the causes of anaemia.\ Review question\ We wanted to know whether erythropoietin therapy in combination with iron before surgery is effective in reducing the need for RBC transfusions in the immediate recovery period in anaemic adults undergoing non‐cardiac surgery, compared to not giving the treatment.\ Erythropoietin therapy can be given by injection below the skin (subcutaneously) or into a vein (intravenously). Iron can be given by mouth (delivered into the gut) or intravenously.\ Study characteristics\ We identified 12 randomized controlled trials involving a total of 1880 adult participants who were anaemic. The participants were randomly1 assigned to a treatment group receiving erythropoietin and iron or a control group. The control group received either placebo (dummy treatment) or no treatment with or without iron. We looked at the following outcomes: haemoglobin concentrations, need for transfusion, the amount of RBC units transfused per participant, adverse events, and any deaths. Erythropoietin was given either in a low dose (150 to 300 international units (IU)/kg body weight) or high dose (500 to 600 IU/kg body weight).\ The evidence is current to August 2019.\ Key results\ We found that giving erythropoietin with iron supplementation reduces the need for RBC transfusions amongst participants (12 studies; 1880 participants). Higher doses of erythropoietin with iron increased haemoglobin concentrations before surgery (7 studies; 1186 participants), but at lower doses any effect was unclear. The number of units of RBCs required was not changed.\ Adverse events did not differ between study groups (10 studies; 1722 participants). Only two studies reported on deaths, with no apparent differences between groups.\ We are uncertain whether adults suffering from preoperative anaemia who were treated with erythropoietin and iron had shorter hospital stays than adults with preoperative anaemia who did not receive preoperative treatment before surgery (3 studies; 293 participants).\ Quality of the evidence\ The quality of the evidence was moderate for the outcome need for RBC transfusion, due to some inconsistency between eligible trials; low for haemoglobin concentration before surgery due to inconsistency between eligible trials and risk of bias; moderate for the amount of RBC units transfused, due to differences in how studies measured the number of units; low for length of hospital stay due to inconsistency in findings and imprecision of the studies; and moderate for mortality and adverse events and death, as only a small number of events were reported.](https://app.figure1.com/case-detail/02af8e8d-9990-48a5-a283-1ec9db5ff829)

\ \ thrombocytopenia in a patient who had a bone marrow transplant four years ago but had a platelet count of 132 two weeks ago . Sent to the emergency room](https://app.figure1.com/case-detail/0668fa94-ffc7-4453-a2ae-2fa25861a663)

\ \ Plasma transfusions before major surgery (other than heart surgery) or invasive procedures, to prevent bleeding\ Review question\ Human plasma, a blood component, is often transfused to people before undergoing surgery or other procedures (such as inserting a chest drainage tube) when blood tests show that their blood may not clot adequately. Aims of this review were to assess how effective this practice is in reducing subsequent bleeding or need for blood transfusion, and whether this approach increases risk of death or other significantly harmful effects. The review excluded people with inherited bleeding disorders and those taking medication that reduces their blood's clotting ability.\ Background\ Human plasma is obtained from blood donors. It contains many factors that help blood to clot. Although plasma may be transfused to people based on blood tests suggesting that their blood may not clot adequately, these tests have limitations. A person's blood may clot adequately despite abnormal test results. Abnormal test results also do not clearly predict those people who will go on to bleed. Furthermore, plasma transfusion corrects abnormal blood tests to varying degrees.\ Plasma is also expensive, and some countries have issues with blood product shortages, donor reliability, and incomplete screening for infections that could be transmitted through blood product transfusion. Given the potential for life‐threatening complications from plasma transfusion, its use in this setting carries risk of harm without clear evidence of benefit.\ Study characteristics\ We included five trials which were all conducted in high‐income countries.\ Our search is current up until 28 January 2019. One trial compared plasma transfusion with no transfusion given. Another trial compared plasma or platelet transfusion or both with neither plasma nor platelet transfusion given. One trial compared plasma transfusion with alternative products given to help blood clot. Another trial compared different blood tests to trigger a plasma transfusion, and still another trial compared different transfusion triggers using the same blood test.\ Four trials involved adult participants over 18 years old, and the fifth trial did not specify age of participants. In four trials, participants underwent bedside procedures. Only one trial involved some participants undergoing major surgical operations. Two trials included only participants in intensive care, and two trials included only participants with liver disease.\ One trial recruited only two participants. Therefore review results include the remaining four trials, incorporating 234 participants. Three further trials are ongoing.\ Key results\ When plasma transfusion was compared with no transfusion given, we are very uncertain whether there was a difference in major bleeding, number of blood transfusions per participant, or harmful effects from the transfusion (1 trial; very low‐quality evidence). When plasma or platelet transfusion or both were compared with neither plasma nor platelet transfusion, we are very uncertain whether there was a difference in mortality within 30 days, or in the number of individuals requiring a transfusion (1 trial; very low‐quality evidence).\ When plasma transfusion was compared with other haemostatic agents, we are very uncertain whether there was a difference in major bleeding or in harmful effects from the transfusion (1 trial; very low‐quality evidence).\ When different triggers for plasma transfusion were compared (1 trial; 60 participants), we are very uncertain whether there was a difference in major bleeding or in harmful effects from the transfusion due to very low‐quality evidence for these outcomes. The number of people requiring blood products may have been reduced overall, although this is based on low‐quality evidence.\ No trials reported procedure‐related harmful events or quality of life as an outcome.\ Quality of the evidence\ The overall quality of the evidence was predominantly very low over a range of clinically important outcomes due to combinations of issues within the studies, such as potential for bias, limited clinical settings, and imprecise estimates of intervention effects.\ Authors' conclusions\ We are very uncertain of the effectiveness and safety of the use of plasma in non‐cardiac operations or invasive procedures due to very low‐quality evidence. Furthermore, as trials do not cover a wide range of surgical contexts, our confidence in applying study results to the wider surgical setting is limited. Overall limited evidence for the utility of plasma transfused to people within this context is of insufficient quality to support or oppose its use.](https://app.figure1.com/case-detail/0dab1df2-c49d-4750-90b5-e963978f3194)

\ \ An overview of Cochrane Reviews on red blood cell transfusions to treat or prevent sickle cell disease-related complications; 15 reviews met the inclusion criteria for this overview. However, only four reviews (which included nine trials and 1052 participants) had results that could be reported.\ Key results\ In the four reviews there was no difference in the risk of death with any comparison. We found that long-term red blood cell (RBC) transfusions compared to standard care, probably decrease the risk of stroke in children and adolescents at high risk of stroke (abnormal transcranial doppler (TCD) ultrasound (high blood flow to the brain) or a previous silent stroke (a stroke with no outward symptoms and where a person is typically unaware they have suffered a stroke)) and may also decrease their risk of painful crisis and acute chest syndrome.\ Red blood cell transfusions may also decrease the risk of silent stroke in children with abnormal TCD ultrasound when compared to standard care.\ There was a lack of evidence for treating adults with SCD-related complications and that important outcomes, including quality of life were often not measured or reported.\ The quality of the trials included in the reviews was variable across the trials and in relation to the outcomes.](https://app.figure1.com/case-detail/1b61f171-ae36-4c55-9188-3e038af13ce5)

Trending now

\ \ A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.\ He had a history of hypertension, long-term smoking, and a sedentary lifestyle.\ On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.](https://app.figure1.com/case-detail/ae0fe999-6875-4474-94f0-ad823dbb9b3a)

\ \ A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.\ Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.](https://app.figure1.com/case-detail/c271070f-2bc7-4052-9895-635277e1a7d5)

\ \ A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.](https://app.figure1.com/case-detail/48f41642-b9db-4089-b120-a94ee52328de)

\ \ patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?](https://app.figure1.com/case-detail/2af390e1-ace8-40ed-ba1c-98fb2d72f4c5)