Platelet Transfusion in Immune Thrombocytopenia: A Status Quo Review
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Abstract
Immune thrombocytopenia is an autoimmune disorder which leads to platelet destruction and low platelet counts. Platelet transfusions are necessary to prevent bleeding complications, and failure to obtain an adequate level of circulating platelets adversely affects survival. Through platelet transfusion bleeding can be limited, but temporarily (for a few hours), so that patients may require repeated transfusions. The use of platelet transfusion in hospitalized patients with immune thrombocytopenia has been increasingly described. The role of platelet transfusions in the treatment of immune thrombocytopenia remains controversial, and it is believed that its clinical benefit could be limited by the shorter survival of transfused platelets. However, it is important to note that its use is often off-label, and therefore it is important to review the state of the art of platelet transfusions in immune thrombocytopenia in the adult population, emphasizing in-hospital outcomes.
Referencias
1. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346(13):995-1008. https://doi.org/10.1056/NEJMra010501
2. Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T, et al. Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv. 2019;3(22):3780-3817. https://doi.org/10.1182/bloodadvances.2019000812
3. Fogarty PF, Segal JB. The epidemiology of immune thrombocytopenic purpura. Curr Opin Hematol. 2007;14(5):515-9. https://doi.org/10.1097/MOH.0b013e3282ab98c7
4. Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190-4207. https://doi.org/10.1182/blood-2010-08-302984
5. Hanson SR, Slichter SJ. Platelet kinetics in patients with bone marrow hypoplasia: evidence for a fixed platelet requirement. Blood. 1985;66(5):1105-9. https://doi.org/ 10.1182/blood.v66.5.1105.1105
6. Storb R, Prentice RL, Buckner CD, Clift RA, Appelbaum F, Deeg J, et al. Graft-versus-host disease and survival in patients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effect of a protective environment. N Engl J Med. 1983;308(6):302-307. https://doi.org/10.1056/NEJM198302103080602
7. Cirasino L, Robino AM, Cattaneo M, Pioltelli PE, Pogliani EM, Terranova L, et al. Appropriate hospital management of adult immune thrombocytopenic purpura patients in major Italian institutions in 2000-2002: a retrospective analysis. Blood Coagul Fibrinolysis. 2010;21(1):77-84. https://doi.org/10.1097/MBC.0b013e328332dbb6
8. Stoll D, Cines DB, Aster RH, Murphy S. Platelet kinetics in patients with idiopathic thrombocytopenic purpura and moderate thrombocytopenia. Blood. 1985;65(3):584-8. https://doi.org/10.1182/blood.v65.3.584.584
9. Baumann MA, Menitove JE, Aster RH, Anderson T. Urgent treatment of idiopathic thrombocytopenic purpura with single-dose gammaglobulin infusion followed by platelet transfusion. Ann Intern Med. 1986;104(6):808-9. https://doi.org/10.7326/0003-4819-104-6-808
10. Salama A, Kiesewetter H, Kalus U, Movassaghi K, Meyer O. Massive platelet transfusion is a rapidly effective emergency treatment in patients with refractory autoimmune thrombocytopenia. Thromb Haemost. 2008;100(5):762-5. https://doi.org/10.1160/TH08-06-0418
11. Spahr JE, Rodgers GM. Treatment of immune-mediated thrombocytopenia purpura with concurrent intravenous immunoglobulin and platelet transfusion: a retrospective review of 40 patients. Am J Hematol. 2008;83(2):122-5. https://doi.org/10.1002/ajh.21060
12. Danese MD, Lindquist K, Gleeson M, Deuson R, Mikhael J. Cost and mortality associated with hospitalizations in patients with immune thrombocytopenic purpura. Am J Hematol. 2009;84(10):631-635. https://doi.org/10.1002/ajh.21500
13. Abrahm J, Ellman L. Platelet transfusion in immune thrombocytopenic purpura. JAMA. 1976;236(16):1847.
14. Carr JM, Kruskall MS, Kaye JA, Robinson SH. Efficacy of platelet transfusions in immune thrombocytopenia. Am J Med. 1986;80(6):1051-4. https://doi.org/10.1016/0002-9343(86)90664-9
15. Chandramouli NB, Rodgers GM. Prolonged immunoglobulin and platelet infusion for treatment of immune thrombocytopenia. Am J Hematol. 2000;65(1):85-6. https://doi.org/10.1002/1096-8652(200009)65:1<85::aid-ajh17>3.0.co;2-9
16. Goel R, Chopra S, Tobian AAR, Ness PM, Frank SM, Cushing M, et al. Platelet transfusion practices in immune thrombocytopenia related hospitalizations. Transfusion. 2019;59(1):169-176. https://doi.org/10.1111/trf.15069
17. Solís M, Rivera A. Solís-Mancilla M, Rivera-Trujillo A, Hernández-Rodríguez S, Carranza Madrigal J. Idoneidad de la transfusión plaquetaria en pacientes con trombocitopenia inmunitaria primaria. Hematol Méx. 2019;20(3):189-97. https://doi.org/10.24245/rhema
18. Cohen YC, Djulbegovic B, Shamai-Lubovitz O, Mozes B. The bleeding risk and natural history of idiopathic thrombocytopenic purpura in patients with persistent low platelet counts. Arch Intern Med. 2000;160(11):1630-8. https://doi.org/10.1001/archinte.160.11.1630
19. Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, et al. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019;3(23):3829-3866. https://doi.org/10.1182/bloodadvances.2019000966
20. Mollison PL, Engelfriet CP, Contreras M, editores. Blood transfusion in clinical medicine. 10.ª ed. Malden (MA): Blackwell Science; 1997.
21. McMillan R. Therapy for adults with refractory chronic immune thrombocytopenic purpura. Ann Intern Med. 1997;126(4):307-14. https://doi.org/10.7326/0003-4819-126-4-199702150-00007

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