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Dr.René TARDIVEL Etablissement Français du Sang. PLATELET TRANSFUSION IN ONCOHAEMATOLOGY. 9 th Maghreb Haematology Conference Sousse 25-26 May 2012. Indications for platelet transfusion. Central thrombocytopenia together with treatment of the cause Thrombopathy, occasional

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Etablissement Français du Sang


9th Maghreb Haematology Conference

Sousse 25-26 May 2012

Indications for platelet transfusion

  • Central thrombocytopenia together with treatment of the cause

  • Thrombopathy, occasional

  • Peripheral thrombocytopenia, exceptional

Platelet concentrates (1)

Principal characteristics

Platelet concentrates (2)

Principal characteristics

Platelet concentrates (3)


  • 5 days (7 days in certain countries in the event of bacterial detection or attenuation of pathogens)

  • Continuous agitation

  • 20-24 °C

  • concentration: 1.2-1.5.106/mm3 (recommendations)

Platelet concentrates (4)

Possible transformations

Platelet concentrates (5)

Possible qualifications

Platelet concentrates (6)


  • No difference in effectiveness

  • No difference in frequency of immunization

  • No product superior to another, but one may be better adapted to the patient

Platelet transfusion indication

Preventive or curative?

Platelet transfusion indication (1)


  • Patient presenting a haemorrhage

Platelet transfusion indication (2)


  • To prevent bleeding associated with thrombocytopenia and/or thrombopathy in a curable patient or a patient with a prolonged life expectancy (bone-marrow transplant, induction of L A,…)

Platelet transfusion - PreventiveDose (1)

Numerous studies seems to show the advantage of strong doses of 4 to 5 10 11

  • Norol F and coll: Platelet transfusion has dose response study Blood 1998; 98:1448 - 1453

  • Klumpp TR and coll: Clinical consequences of alterations in platelet transfusion dose: prospective, randomized, double-blind trial transfusion 1999; 39:674 - 681

  • Sensebe et al: The efficacy of high-dose patient transfusions of platelets in hematology thrombocytopenic patients: result of prospective, randomized, open blinded end point (PROBE) study Blood 2005 105: 862-864

Platelet transfusion - PreventiveDose (2)

However, other studies show that a low dose 2-3 1011 can also be effective

  • Tinmouth A et al: Low-dose prophylactic platelet transfusions in recipients of an autologous peripheral blood progenitor cell transplant and patients with acute leukemia: a randomized controlled trial with sequential Bayesian design. Transfusion 2004; 44: 1711-1719.

  • Heddle NR et al (Best ISBT Working party) Study STOP low dose 1.5 -3.1011 versus standard amounts 4-6.1011. Study stopped in 2008 because of the higher frequency of haemorraging in the low-dose group

  • Slichter S et al: Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage N England journal of medicine 2010; 362:600 - 613

Platelet transfusion - PreventiveDose (3)

Study PLADO (Optimal Platelet Dose Strategy for Management of Thrombocytopenia)

  • 3 doses of platelets: 1.1-1011/m2



  • Low doses involve a reduction in the transfused platelets but increases the number of transfusions (5 versus 3 for average and high doses)

  • Weak or strong doses do not have an effect on the frequency of the bleedings

  • No significant difference when with the number of days before appearance of grade 2 bleeding or higher, no matter what the dose

Platelet transfusion - Preventivetransfusional thresholds (1)

Pietersz R.N.I International Forum –Prophylactic platelet transfusion – Vox Sanguins 2012

14 responses by different countries

  • In the absence of risk factor

    10.109/l (except Russia and in certain indications from Japan and the Netherlands: 5-109/l

Platelet transfusion - Preventivetransfusional thresholds (2)

  • In the event of risk factors

    Fever >38.5°C, evolutionary sepsis, coagulation anomaly, thrombopathy, anaemia, mucite, extensive purpura, haemorrhage inside the eye, HTA, anatomical lesions

    Threshold up to 20.109/l

Platelet transfusion - Preventivetransfusional thresholds (3)

  • Other situations

    Invasive techniques: catheter, implantable chamber, fibroscopy, biopsy, broncho-alveolar washing

    Surgery, severe haemorrhage, CIVD,…

    Threshold raised to 50.109/l or above

Platelet transfusion Dose in practice

  • Recommendation AFSSaPS or ANSM

    • 0.5.1011 for every 7 kg of patient weight

    • (or average dose suggested in PLADO study)

Platelet transfusion

Evaluation of effectiveness

- Curative:

Stopping bleeding

- Preventive:

 Increase in platelet count after transfusion

 Duration of transfusional effectiveness (3-4 days)

 Prevention of thrombocytopenia-related haemorrhages

 RTP > 20% and/or CCI > 7

  • Platelet transfusion yield (PTY)

  • [PC after transfusion-PC before transfusion] X weight (kg) X 0.075

  • PTY =

  • Number of platelets transfused (X 1011)

  • PC: platelet count

  • Corrected Count Increment (CCI)

  • [PC after transfusion - PC before transfusion] X body surface area (m2) X 100

  • CCI=

  • Number of platelets transfused (X 1011)

PC: platelet count

R=0.9898correlation CCI/PTY (365 values)



Data EFS Bretagne

CHU Rennes


(Pr. Thierry Lamy)

Follow-up of the output of platelet transfusion

Study of transfusion efficiency after transfusions of single donor-apheresis platelet concentrates and random-donor platelet concentrates


June 2007


  • From 05/05/2005 to 09/04/2007

  • 3496 platelet transfusions

  • 2354 SD-APC

  • 1141 RD-PC



Distribution of the plates transfused according to age

(N = 11207)


J1 J2 J3 J4 J5

3.3% 20.5% 28% 34% 14.2%

Distribution CPA/MCP

CPA: 41%

MCP: 59%

  • Tests de Comparaison des moyennes : utilisation du t de Student. La valeur de ce test doit être supérieure à 1.96 pour accepter à 95% l’hypothèse selon laquelle les moyennes observées sont différentes.

  • Statistiquement, nous pouvons appliquer ce test de Student après avoir vérifié l’homogénéité des variances. Le test de Fischer-Snedecor nous permet de valider cette homogénéité car dans chacun des cas, le rapport de la variance la plus élevée sur la variance la plus faible est inférieur à la valeur théorique de 1.57.

  • Comparaisons des moyennes :

    • CPA Intersol et CPA Plasma : F=1.15 et t=5.5  les moyennes sont différentes.

    • CPA SSP+ et CPA Plasma : F=1.18 et t=1.2  les moyennes sont identiques.

    • CPA SSP+ et MCP SSP+ : F=1.22 et t=0.5  les moyennes sont identiques.

    • MCP SSP+ et CPA Plasma : F=1.03 et t=1.1  les moyennes sont identiques.

  • En jaune, les moyennes significativement différentes :

    • J5 rendement moindre que J4 pour CPA Plasma

    • CPA/MCP SSP+ : les moyennes de rendement à 1 jour près peuvent sembler décroître selon l’ancienneté du PSL, mais statistiquement ces moyennes comparées au jour près sont identiques et ne présentent pas de différence.

La valeur du t de Student ici compare le rendement moyen de l’âge du PSL sur la ligne concernée avec la ligne juste au dessus : ex : J5 vs J4


  • 4459 PC Transfusions

  • 1219 Recipients

  • 2264 yeld > 20% ( 60% PC Transfusions)

Platelet transfusion

Inefficiency if output < 20% or CCI <7

  • Platelet concentrate

    • Insufficient dose

    • Altered platelets (transport, conservation… c.f. index of spinning)

    • Plaquettes proches date de péremption

    • Incompatible ABO

  • Patient

    • Fever, CIVD, splenomegaly, drug

    • Alloimmunisation HLA or HPA = refractory state (polytransfused, multipair)

Platelet transfusion

Refractory state

Output < 20% or CCI < 7 on the results of the count made 1 to 24 hrs after a second transfusion of a concentrate of platelets:

  • Compatible ABO

  • Less than 48h of storage

  • Having a sufficient quantity of platelets (0.5 * 1011/7kg)

Antigenic systems and alloimmunisation antiplatelets

Non alloimmune



Leucocytic contamination






CSH graft


Auto antibody

Immunoallergic antibodies




Anti class I


Unknown frequency, probably weak

Often not recognised


Sometimes forgotten

Causes of the refractory states to platelet transfusions

Study TRAP (Trial to Reduce Alloimmunization to Platelets Study Group N. Eng. J. Med. 1997)

  • Co-operative study 530 LAM

  • 4 groups of patients:

    • Transfused with pools of concentrates of normal platelets

    • Transfused with pools of concentrates of platelets treated with UV-B

    • Transfused with pools of concentrates of leucocyte-reduced platelets by filtration

    • Transfused with concentrates of platelets of apheresis with leucocytes reduced by filtration

TRAP study(Trial to Reduce Alloimmunization to Platelets Study Group N. Eng. J. Med. 1997)

  • Refractory state:

    • 2 consecutive ineffective transfusions,CCI in the hour following the transfusion < 5000/ L/m2

    • Compatible ABO

    • At least one of the two concentrates stored for less than 48 hrs.

  • Anti-HLA

    • MLCT sensitized by an antiglobuline

    • 60% cytotoxicity in 1 cell or 40% in 2

    • Tests prior to beginning of protocol and then every week for eight weeks

  • Anti-HPA

    • Detection: ELISA and flow cytometry

    • Confirmation: method of capture ELISA

TRAP Study (NR. Eng.J.Med. 1997)refractory states (RS) withtransfusions of platelets and alloimmunisation

Risk factors of alloimmunisation

  • Preliminary sensitizing

    • Previous blood transfusions without leucocyte reduction

    • Prevopis pregnancies 62% vs 33% of immunization with/without leucocyte reduction (TRAP study)

    • Pilot 32% vs 10% of immunization with products without leucocyte reduction vs products with leucocyte reduction (TRAP study)

Platelet transfusion

What to do in the event of a refractory state?

  • search for AC anti HLA /HPA

  • Search for compatible platelets: phenotype CPA



  • MCP

Platelet transfusion

Other complications

  • Nonhemolytic feverish reactions

  • Anti-erythrocyte alloimmunization (rhesus)

  • Allergy

  • Haemolytic accidents (haemolysins)

  • GVHD

  • Transmission of viruses, bacteria, parasitic infectious diseases


  • Post-transfusional purpura

Platelet transfusion

Prevention of complications

  • RFNH: fresh platelets, deleucocytation, (deplasmatisation)

    premedication of the recipient

  • Alloimmunization anti D:

    Selection of platelets from Rh negative donor (protection future obstétrical +++)+++)

    Ig anti D

    Passive anti D monitoring

  • Allergy:

    Prefer additive platelets in solution to platelets in plasma, (deplasmatisation?)

Platelet transfusion

  • Haemolytic accidents (by AC immune ABO)

    Detection of haemolysins

    Respect Iso group if possible

    Plasma removal

  • GVHD


  • Transmission of infectious diseases

    Tracking of viruses: HBV, HCV, HIV, MVC

    For the bacteria: medical maintenance, good disinfection of the intake point, rules of hygiene, information post donation

Platelet transfusion

Transmission of infectious diseases (continued)

For parasites: forty donors when returning from endemic areas

Attenuation of pathogens: Amotosalen, Riboflavin, UVC, but deterioration of the platelet function involving of the more frequent transfusions

Platelet transfusion


    • Not-transfused male subjects

    • Nulliparous women

    • Multiparous negative ac anti HLA

Post-transfusional purpura

  • Identification

    • Typical form of brutal thrombocytopenia one week after the transfusion of a blood product containing of the platelets

    • Atypical form: refractory thrombocytopenia with the transfusions of platelets

  • Diagnosis

    • In addition to frequently present anti HLA, look for anti-HPA interest of MAIPA with ac monoclonal suitable

  • Treatment

    • Generally ineffective transfusion since PR associates an anti HPA reaction automatically with an allo reaction

    • Plasma transplant

    • IVIG

Platelet transfusion


  • Two products with identical effectiveness: CPA and MCP

  • Preserved in plasma or additive solution (PAS)

  • Able to use transformations or qualifications (phenotype, test of compatibility, negative CMV) to adapt to the needs of the patient

  • The selection, dose, and monitoring of platelet transfusions must be subject to dialogue between the prescriber and the transfusion centre


  • Pr. Jean-Yves Muller

  • Dr.Julie Vasse

  • Mme Soline Gaucheron

  • Mr Jean-Pierre Lebaudy

  • Distribution team

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