How I use platelet transfusions

被引:24
|
作者
Stanworth, Simon J. [1 ,3 ,4 ,6 ]
Shah, Akshay [2 ,5 ]
机构
[1] Oxford Univ Hosp Natl Hlth Serv NHS Fdn Trust, Dept Haematol, Oxford, England
[2] Oxford Univ Hosp Natl Hlth Serv NHS Fdn Trust, Nuffield Dept Anaesthesia, Oxford, England
[3] Univ Oxford, Radcliffe Dept Med, Oxford, England
[4] NHS Blood & Transplant, Oxford, England
[5] Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England
[6] John Radcliffe Hosp, NHS Blood & Transplant, Level 2,Headley Way, Oxford OX3 9BQ, England
关键词
ACUTE LUNG INJURY; CENTRAL VENOUS CATHETER; CRITICALLY-ILL PATIENTS; FRESH-FROZEN PLASMA; HEMATOLOGICAL MALIGNANCIES; CD40; LIGAND; OPEN-LABEL; ACTIVATED PLATELETS; BLOOD COMPONENTS; STORED PLATELETS;
D O I
10.1182/blood.2022016558
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Platelet transfusions are commonly administered for the prevention or treatment of bleeding in patients with acquired thrombocytopenia across a range of clinical contexts. Recent data, including randomized trials, have highlighted uncertainties in the risk-benefit balance of this therapy, which is the subject of this review. Hemovigilance systems report that platelets are the most frequently implicated component in transfusion reactions. There is considerable variation in platelet count increment after platelet transfusion, and limited evidence of efficacy for clinical outcomes, including prevention of bleeding. Bleeding events commonly occur despite the different policies for platelet transfusion prophylaxis. The underlying mechanisms of harm reported in randomized trials may be related to the role of platelets beyond hemostasis, including mediating inflammation. Research supports the implementation of a restrictive platelet transfusion policy. Research is needed to better understand the impact of platelet donation characteristics on outcomes, and to determine the optimal thresholds for platelet transfusion before invasive procedures or major surgery (eg, laparotomy). Platelet transfusion policies should move toward a risk-adapted approach that does not focus solely on platelet count.
引用
收藏
页码:1925 / 1936
页数:12
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