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Haematological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
The purpose of platelet transfusion is to increase the platelet count from a level causing bleeding or increased bleeding risk to one that does not. Surgery requires different platelet thresholds depending on the site and bleeding risk. Abdominal surgery including caesarean section can safely be performed with platelet counts >50 × 109/L while neurosurgery and ophthalmic surgery require the platelet count to be 100 × 109/L or greater.
Postpartum hemorrhage
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Wade D. Schwendemann, William J. Watson
Once coagulation studies are available, or sooner if there is an abnormal clot tube, or if clinically indicated, clotting factors should be replaced as well. In order to replace platelets, platelet transfusion is performed. Most conventional blood banks will perform transfusion in terms of units of platelets, but some will still use the term “six pack,” which refers to six units of platelets. Transfusion of each unit of platelets can be expected to raise the platelet count by 5 to 10 K/dL. Correction of the underlying cause of platelet consumption is critical or these platelets may undergo the same consumption that initially caused the thrombocytopenia.
An Updated Overview of the Medical Management of Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
Lila S. Nolan, Martin Goree, Misty Good
Hematological analysis during NEC may show findings of thrombocytopenia, which is attributed to the inflammatory response, acidosis, or intestinal ischemia (24). The presence of persistent or severe thrombocytopenia is suggestive of severe disease in NEC and can be an indication that surgery is needed (2). The indications and thresholds for platelet transfusion are variable and should be considered in the presence of signs of clinical bleeding. Recent evidence suggests that neonatal platelet transfusions administered using a restrictive platelet count threshold of 25,000 per cubic millimeter results in lower rates of death or major bleeding as compared with a higher platelet count threshold of 50,000 per cubic millimeter (25). Importantly, infants have been noted to have variable responses to platelet transfusions due to the platelet consumption that occurs during NEC or sepsis (24).
Platelet-derived extracellular vesicles play an important role in platelet transfusion therapy
Published in Platelets, 2023
Zhi Cai, Junyan Feng, Nian Dong, Pan Zhou, Yuanshuai Huang, Hongwei Zhang
As a multifunctional immune cell, platelet transfusion is a “cell transplantation” that can actively participate in the immune regulation of the host, which may harm the efficacy of transfusion.23 Numerous mediators produced during platelet storage are involved in a variety of adverse reactions, leading to an increased risk of platelet transfusion and shortened infusion intervals.24 What’s more, PEVs produced during storage are highly homologous to platelets, have similar functions to platelets, and mediate intercellular communication.7,8 PEVs are believed to be related to enhanced platelet aggregation and regulation of the immune system, may influence the efficacy of platelet transfusion, and participate in the adverse reactions of immune transfusion.2,7,8
Additional efficacy analysis of avatrombopag phase III data for the treatment of adults with immune thrombocytopenia
Published in Platelets, 2023
Shivi Jain, Terry Gernsheimer, Scott Kolodny, Chelsea Bernheisel, Michael Vredenburg, Sandhya R. Panch
Durability of the initial avatrombopag response (platelet count ≥ 50 × 109/L) was assessed as the mean (standard deviation [SD]) number of days until loss of response (LOR), study completion, or study discontinuation; proportion of patients with no LOR, and mean (SD) proportion of time with response in responding patients (e.g., total time responding). Duration of response was analyzed for all patients achieving a response in the core phase (total population; divided by treatment group) and for all patients achieving a response to avatrombopag in the core and extension phase (total population and according to previously mentioned subgroups). LOR was defined as platelet count <30 × 109/L over two consecutive scheduled visits. A broader definition of LOR for 4 consecutive weeks was also used (data not shown). The date of the first platelet count <30 × 109/L was used as the starting point for the LOR calculation. If patients required corticosteroids or intravenous immunoglobulin as rescue therapy, they were considered non-responders for at least 8 weeks after the date the rescue therapy was administered. If patients received a platelet transfusion, they were considered non-responders for at least 1 week after the date the transfusion was administered.
Real-world burden of chemotherapy-induced myelosuppression in patients with small cell lung cancer: a retrospective analysis of electronic medical data from community cancer care providers
Published in Journal of Medical Economics, 2022
Robert S. Epstein, Roshanthi K. Weerasinghe, Amy S. Parrish, JoAnn Krenitsky, Rachel E. Sanborn, Tehseen Salimi
The most frequently used treatment for myelosuppressive AEs across all patients was G-CSF, with an incidence of 47.0 per 100 patients (1.7 prophylactic and 45.6 therapeutic; Table 2). The rate of G-CSF use during 1L (40.5 per 100 patients; 1.7 prophylactic and 40.2 therapeutic) was higher than during 2L (17.6 per 100 patients; 0 prophylactic and 17.6 therapeutic). RBC transfusion was the second-most frequently used treatment, with an incidence of 41.7 per 100 patients (1L: 31.4; 2L: 41.2). The incidence of platelet transfusion was 13.3 per 100 patients (1L: 9.2; 2L: 11.8). The use of ESAs was low, at 2.0 per 100 patients (1L: 2.0; 2L: 1.9). There was a trend toward increased use of supportive care interventions among patients with AEs in more than one lineage (Table 4). For example, 25% of patients with no myelosuppressive AEs received G-CSF, vs. 54, 66, and 67% of patients with AEs across one, two, and three lineages, respectively.