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2015 ; 5
(1
): 46
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Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia
in the intensive care unit
#MMPMID26621198
Habr B
; Charpentier J
; Champigneulle B
; Dechartres A
; Daviaud F
; Geri G
; Cariou A
; Chiche JD
; Mira JP
; Pène F
Ann Intensive Care
2015[Dec]; 5
(1
): 46
PMID26621198
show ga
BACKGROUND: Thrombocytopenia is a frequent finding in critically ill cancer
patients for whom indications of platelet transfusions are unclear. We herein
addressed the current practices in platelet transfusion and the risk of bleeding
in cancer patients with hypoproliferative thrombocytopenia in the intensive care
unit (ICU). METHODS: A retrospective monocenter study over a 7-year period was
conducted in a medical ICU. Adult patients with malignancies and
hypoproliferative thrombocytopenia, and who received at least one platelet
concentrate during their ICU stay, were included. RESULTS: 296 patients were
included and received a total of 904 platelet transfusions, for prophylactic
indications in 300 (33.2 %) episodes, for securing an invasive procedure in 257
(28.4 %), and for treatment of minor to major bleeding manifestations in 347
(38.4 %). Most prophylactic transfusions (80 %) were performed at platelet count
thresholds below 10-20 × 10(9)/L. Platelet increments were generally low in all
three indications, 10 (interquartile range 2-25), 11 (2-25), and 8
(0-21) × 10(9)/L, respectively. A total of 97 major ICU-acquired bleeding events
occurred in 40 patients. About half of those bleeding episodes (54.7 %) occurred
at platelet counts below 20 × 10(9)/L. However, neither low admission platelet
count nor low nadir platelet counts were predictive of ICU-acquired bleeding. The
in-ICU mortality rate tended to be higher in patients with severe ICU-acquired
bleeding events (50 vs. 36 %). CONCLUSIONS: Most prophylactic platelet
transfusions were given using thresholds of 10-20 × 10(9)/L in critically ill
thrombocytopenic cancer patients. The individual risk of ICU-acquired severe
bleeding appears hardly predictable with the depth of thrombocytopenia.