Comparison of Prophylactic and Therapeutic Platelet Transfusion Strategies in Manitoba: A Retrospective Cohort Study

• Published in: Blood 2024-11, Vol.144, p.7311-7311
• Main Authors: Soriano, Andrea, Houston, Brett L., Sriranjan, Neelan, Rimmer, Emily K., Houston, Donald Stuart, Zarychanski, Ryan, Paulson, Kristjan, Ayilara, Olawale, Moore, Tyler
• Format: Article
• Language: English
• ISSN: 0006-4971
• DOI: 10.1182/blood-2024-204178

Background:Autologous bone marrow transplantation (BMT) is associated with severe thrombocytopenia, yet optimal use of platelet transfusions is unclear. Subgroup analyses from prior trials1,2 demonstrated no difference in major bleeding among patients treated with prophylactic (to prevent bleeding) or therapeutic (to treat bleeding) platelet transfusion strategies, although total blood product use was reduced when a therapeutic approach was used. Guidelines suggest avoiding prophylactic platelet transfusions in autologous BMT in the absence of bleeding3,4, yet there has been variable uptake of a therapeutic platelet transfusion strategy among centres performing autologous BMT. In 2018 we adopted a policy of therapeutic rather than prophylactic platelet transfusion among patients undergoing autologous BMT; our prior policy was to prophylactically transfuse when the platelet count fell below 10x109/L. We compared bleeding outcomes and overall blood product utilization among patients undergoing autologous BMT treated before and after our change in platelet transfusion policy. Methods:We conducted a retrospective cohort study of all adult patients undergoing autologous BMT for hematologic malignancy in Manitoba, CAN from 2013-2022. Patients were identified, and demographic and clinical information were obtained from the Manitoba Blood and Marrow Transplant Program registry. Hospital records were reviewed to assess bleeding frequency and severity using the modified World Health Organization bleeding scale5. Transfusion data were obtained from the provincial transfusion database. Transplants conducted before and after June 2018 defined our ‘pre’ and ‘post’ cohort, respectively. Baseline characteristics were summarized as means (standard deviation [SD]), medians (interquartile range [IQR]) or frequency (percent), as appropriate. Logistic regression was performed to assess differences in WHO grade 2+ bleeding, controlling for age, sex, comorbidity score, diagnosis, conditioning regimen, number of days with platelet count