The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy.

2.50
Hdl Handle:
http://hdl.handle.net/10541/80277
Title:
The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy.
Authors:
Callow, Colin R; Swindell, Ric; Randall, William; Chopra, Rajesh
Abstract:
Indications for platelet transfusion remain controversial and are frequently based on arbitrary numerical criteria. In October 2000, we introduced a stringent prophylactic-platelet transfusion policy < 10 x 109/l for stable patients and < 20 x 10(9)/l in the presence of major bleeding or additional risk factors. A trigger of < 50 x 10(9)/l was introduced for patients undergoing invasive procedures. A prospective analysis was performed measuring the frequency of minor and major bleeding events, morbidity, mortality and duration of pancytopenia. Blood product usage was assessed and health care savings measured. A total of 98 patients were evaluated on 2147 patient study days and 271 bleeding episodes were recorded. Major bleeding occurred on 1.39% (30/2147) of the study days when platelet counts were < 10 x 10(9)/l and 2.3% (50/2147) of the study days when platelet counts were 10-20 x 10(9)/l. In patients with platelets > 20 x 10(9)/l, there were 117 major bleeding episodes observed on 5.4% of the study days. In patients with no identified additional risk factors present, major haemorrhages were recorded in 0.51% (11/2147) of the study days in patients with platelet counts > or = 10 x 10(9)/l . There was a 36% reduction in platelet units transfused compared with retrospective data when an arbitrary transfusion trigger of 20 x 10(9)/l was in place (P = < 0.02). Of note, a 16% reduction in red cell transfusions was recorded. These data confirm that the introduction of a transfusion trigger of < 10 x 10(9)/l in the absence of fresh bleeding and sepsis (> 38 degrees C) is safe and has a significant impact on overall hospital transfusion costs.
Affiliation:
Department of Haematological Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK. Colin.Callow@christie-tr.nwest.nhs.uk
Citation:
The frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy. 2002, 118 (2):677-82 Br. J. Haematol.
Journal:
British Journal of Haematology
Issue Date:
Aug-2002
URI:
http://hdl.handle.net/10541/80277
PubMed ID:
12139764
Type:
Article
Language:
en
ISSN:
0007-1048
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorCallow, Colin R-
dc.contributor.authorSwindell, Ric-
dc.contributor.authorRandall, William-
dc.contributor.authorChopra, Rajesh-
dc.date.accessioned2009-09-08T11:16:25Z-
dc.date.available2009-09-08T11:16:25Z-
dc.date.issued2002-08-
dc.identifier.citationThe frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy. 2002, 118 (2):677-82 Br. J. Haematol.en
dc.identifier.issn0007-1048-
dc.identifier.pmid12139764-
dc.identifier.urihttp://hdl.handle.net/10541/80277-
dc.description.abstractIndications for platelet transfusion remain controversial and are frequently based on arbitrary numerical criteria. In October 2000, we introduced a stringent prophylactic-platelet transfusion policy < 10 x 109/l for stable patients and < 20 x 10(9)/l in the presence of major bleeding or additional risk factors. A trigger of < 50 x 10(9)/l was introduced for patients undergoing invasive procedures. A prospective analysis was performed measuring the frequency of minor and major bleeding events, morbidity, mortality and duration of pancytopenia. Blood product usage was assessed and health care savings measured. A total of 98 patients were evaluated on 2147 patient study days and 271 bleeding episodes were recorded. Major bleeding occurred on 1.39% (30/2147) of the study days when platelet counts were < 10 x 10(9)/l and 2.3% (50/2147) of the study days when platelet counts were 10-20 x 10(9)/l. In patients with platelets > 20 x 10(9)/l, there were 117 major bleeding episodes observed on 5.4% of the study days. In patients with no identified additional risk factors present, major haemorrhages were recorded in 0.51% (11/2147) of the study days in patients with platelet counts > or = 10 x 10(9)/l . There was a 36% reduction in platelet units transfused compared with retrospective data when an arbitrary transfusion trigger of 20 x 10(9)/l was in place (P = < 0.02). Of note, a 16% reduction in red cell transfusions was recorded. These data confirm that the introduction of a transfusion trigger of < 10 x 10(9)/l in the absence of fresh bleeding and sepsis (> 38 degrees C) is safe and has a significant impact on overall hospital transfusion costs.en
dc.language.isoenen
dc.subjectHaemorrhageen
dc.subjectHaematologic Canceren
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshClinical Protocols-
dc.subject.meshFemale-
dc.subject.meshHematologic Neoplasms-
dc.subject.meshHemorrhage-
dc.subject.meshHumans-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPlatelet Count-
dc.subject.meshPlatelet Transfusion-
dc.subject.meshProspective Studies-
dc.subject.meshRetrospective Studies-
dc.subject.meshRisk Factors-
dc.subject.meshThrombocytopenia-
dc.titleThe frequency of bleeding complications in patients with haematological malignancy following the introduction of a stringent prophylactic platelet transfusion policy.en
dc.typeArticleen
dc.contributor.departmentDepartment of Haematological Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK. Colin.Callow@christie-tr.nwest.nhs.uken
dc.identifier.journalBritish Journal of Haematologyen

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