Clinical consequences of alterations in platelet transfusion dose: a prospective, randomized, double‐blind trial

Abstract

BACKGROUND: The dose‐response relationship for platelet transfusion has become increasingly important as the use of platelet transfusion has grown. STUDY DESIGN AND METHODS: One hundred fifty‐eight prophylactic apheresis platelet transfusions were administered to 46 patients undergoing high‐dose therapy followed by hematopoietic progenitor cell transplantation in a prospective, randomized, double‐blind, multiple‐crossover study. Transfusions were administered in pairs, differing only in platelet content. Each pair consisted of a lower‐dose platelet component (LDP) and a higher‐dose platelet component (HDP) administered in random order to the same patient. LDPs contained a mean of 3.1 × 10¹¹ platelets (range, 2.3‐3.5 × 10¹¹), and HDPs contained a mean of 5.0 × 10¹¹ platelets (range, 4.5‐6.1 × 10¹¹). Patients with active bleeding and those who were refractory to platelet transfusions were excluded. RESULTS: The mean posttransfusion platelet count increment with LDP was 17,010 per μL, and that with HDP was 31,057 per μL (p20,000 per μL, a shorter transfusion‐free interval, and a greater relative risk per day of requiring additional transfusions.