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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.
Ganglioside GD2 Specific Antibodies in the Diagnosis and Therapy of Human Neuroblastoma
Published in John T. Kemshead, Pediatric Tumors: Immunological and Molecular Markers, 2020
Nai-Kong V. Cheung, Floro D. Miraldi
The major toxicity was marrow hypoplasia. All three patients developed thrombocytopenia nadiring around 25 days after 131I-3F8. All three required frequent platelet transfusions for about 3 to 4 weeks before recovery of platelet counts to above 50,000. Neutropenia (ANC or absolute neutrophil count <1000/mm3) was also evident during the same period. The degree of neutropenia varied among the three patients (ANC nadirs of <100, 300, and 900/mm3, respectively). All three required 55 to 70 days to recover their pretreatment ANC level. Absolute lymphocyte counts decreased rapidly within the first 6 days and then quickly recovered. None of the three patients had bleeding or infectious complications that required hospitalization.
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.
Clinical pharmacology of antiplatelet drugs
Published in Expert Review of Clinical Pharmacology, 2022
Georg Gelbenegger, Bernd Jilma
Abciximab, eptifibatide and tirofiban can cause profound, transient thrombocytopenia in 0.5% to 5% of treated patients [154]. GPIIb/IIIa inhibitor-induced thrombocytopenia is immune-mediated and typically encountered within several hours of exposure [155,156]. Contrary to other drug-induced thrombocytopenias, thrombocytopenia caused by GPIIb/IIIa inhibitors does not require prior exposure to the triggering agent [157]. The rapid onset of thrombocytopenia may be explained by the presence of preformed, naturally occurring antibodies [158–162], but their exact mechanism of causing thrombocytopenia remains unclear [163]. The clinical picture of patients with GPIIb/IIIa inhibitor-induced thrombocytopenia is variable, ranging from asymptomatic courses to major bleedings to dyspnea, hypotension and anaphylactic reactions [164]. In case of life-threatening or major bleeding, platelet transfusions should be administered. Patients with severe bleeding may receive platelet transfusions even if the thrombocytopenia is not severe, because of the additional antiplatelet effect of GPIIb/IIIa inhibitors on the remaining platelets in circulation. Glucocorticoids and intravenous immune globulin (IVIG) may be additionally used. Upon drug discontinuation, the platelet count is expected to increase within one or two days and returns to the patient’s normal range within a week [165].