Thrombocytopenia in the cancer patient
Thrombocytopenia is commonplace in patients receiving cytotoxic chemotherapy. The trigger level to transfuse platelets is not always absolute. Spontaneous bleeding is unlikely if platelets are >20 x 109/l, but the risk of traumatic bleeding is greater if <40 x 109/l. Most clinicians would transfuse when platelets are <10 x 109/l. However, if there is active bleeding, many clinicians would transfuse if <50 x 109/l.
Careful consideration of the patient's vascular status, clotting status, and disease risks (e.g. gastric carcinoma) will determine the threshold for transfusion in an individual patient. Cross-matching is not required since patients generally receive random, pooled, donor platelets.
Some patients may become refractory after repeated transfusions and HLA-matched platelets should be used. Four units of fresh platelets, (doubled if platelets greater than three days old), should raise the count to >24-40 x 109/l in an adult. Although frequently part of the differential diagnosis of refractoriness, HLA allo-immunization is only one of many causes. Others include the presence of:
♦ Anti-platelet antibodies
♦ Disseminated intravascular coagulation
♦ Concomitant drugs e.g. septrin
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