How low can you go: What is the safe threshold for platelet transfusions in patients with hematologic malignancy in sub-Saharan Africa

• Published in: PloS one 2019-02, Vol.14 (2), p.e0211648-e0211648
• Main Authors: Ddungu, Henry, Krantz, Elizabeth M, Kajja, Isaac, Naluzze, Sandra, Nabbanja, Hanifah, Nalubwama, Flavia, Phipps, Warren, Orem, Jackson, Kiwanuka, Noah, Wald, Anna
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Audits; Biology and Life Sciences; Bleeding; Blood & organ donations; Blood cancer; Blood platelets; Blood products; Blood transfusions; Cancer; Cancer patients; Cancer research; Cancer treatment; Care and treatment; Chemotherapy; Child; Child, Preschool; Female; Glycosylated hemoglobin; Health sciences; Hematologic Neoplasms - therapy; Hematology; Hemoglobin; Hemoglobins; Hemoglobins - analysis; Hemorrhage - etiology; Hospitals; Humans; Infant; Infectious diseases; Leukemia; Lymphoma; Male; Malignancy; Medical research; Medical schools; Medicine; Medicine and Health Sciences; Methods; Middle Aged; Mortality; Patients; People and Places; Platelet transfusion; Platelet Transfusion - adverse effects; Platelet Transfusion - methods; Platelets; Prospective Studies; Statistics; Stem cells; Thrombocytopenia; Transfusion; Transplants & implants; Uganda; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0211648

Despite the importance of platelet transfusions in treatment of hematologic cancer patients, the optimal platelet count threshold for prophylactic transfusion is unknown in sub-Saharan Africa. We followed patients admitted to the Uganda Cancer Institute with a hematological malignancy in 3 sequential 4-month time-periods using incrementally lower thresholds for prophylactic platelet transfusion: platelet counts ≤ 30 x 109/L in period 1, ≤ 20 x 109/L in period 2, and ≤ 10 x 109/L in period 3. Clinically significant bleeding was defined as WHO grade ≥ 2 bleeding. We used generalized estimating equations (GEE) to compare the frequency of clinically significant bleeding and platelet transfusions by study period, adjusting for age, sex, cancer type, chemotherapy, baseline platelet count, and baseline hemoglobin. Overall, 188 patients were enrolled. The median age was 22 years (range 1-80). Platelet transfusions were given to 42% of patients in period 1, 55% in period 2, and 45% in period 3. These transfusions occurred on 8% of days in period 1, 12% in period 2, and 8% in period 3. In adjusted models, period 3 had significantly fewer transfusions than period 1 (RR = 0.6, 95% CI 0.4-0.9; p = 0.01) and period 2 (RR = 0.5, 95% CI 0.4-0.7; p