Slichter, S.J., Kaufman, R.M., Assmann, S.F., McCullough, J., Triulzi, D.J., Strauss, R.G., . . . Granger, S. (2010). Dose of prophylactic platelet transfusions and prevention of hemorrhage. New England Journal of Medicine, 362(7), 600–613. 

DOI Link

Study Purpose

To determine the effect of the dose of platelets (high, medium, or low) on bleeding with secondary aims to determine the effect of this dose upon grade of bleeding, number of platelets transfused, and number of transfusions

Intervention Characteristics/Basic Study Process

Hospitalized patients were randomly assigned by a computer at a 1:1:1 ratio to receive prophylactic platelet transfusion at either a low dose, a medium dose, or a high dose (1.1 × 1011, 2.2 × 1011, or 4.4 × 1011 platelets per square meter of body-surface area) when morning platelet counts were 10,000 per cubic millimeter or lower for five days or more. Site staff was not told the patients' specific assigned dose; however, complete blindness was prevented because of differences in transfusion volume. A blood transfusion service provided the assigned dose within the allowable range of ± 25% for this study. Treating physicians could change the trigger threshold for a patient if clinically indicated. The patient would return to the study protocol trigger as soon as possible. Site-specific guidelines were used to determine red cell infusions. Patients were assessed daily for 30 days after the first infusion, at a 10-day period without a platelet transfusion, at discharge, at death, or at withdrawal from the study.

Sample Characteristics

N = 1272

MEDIAN AGE: 47 years (low-dose), 50 years (medium-dose), 51 years (high-dose)

MALES: 60.4%, FEMALES: 39.6%

KEY DISEASE CHARACTERISTICS: Patients undergoing hematopoietic stem cell transplants or chemotherapy for hematologic cancers or solid tumors
 
OTHER KEY SAMPLE CHARACTERISTICS: Other required criteria were weight 10–135 kg; PT and PTT 1.3 times the upper limit of the normal range or less; fibrinogen of 100 mg per deciliter or more; and no other platelet transfusion during the current hospitalization. 

Setting

  • SITE: Multi-site 
  • SETTING TYPE: Inpatient  
  • LOCATION: All around the country

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
 
 

Study Design

Randomized, controlled trial

Measurement Instruments/Methods

  • World Health Organization (WHO) criteria
  • Physical examinations
  • Interviews with patients
  • Chart reviews for bleeding events
  • Platelet counts, hematocrit values, and hemoglobin values  

Results

There was no significant difference between the percentages of patients who a received low, medium, or high dose of platelets and bleeding.

Conclusions

There is no significant difference in the volume of platelets given after the trigger of 10,000 for patients. Based on these results, using the lower volume of platelets would preserve the already decreased volume of available platelet products.

Limitations

  • Risk of bias (no blinding)

Nursing Implications

Nurses were not blinded on this study due to the fact that they were aware of the volume that was transfused; however, this would not affect the amount of volume that was delivered to the patient. Nurses are involved in the assessment of bleeding, transfusion, and monitoring of laboratory values.