The majority of platelet transfusions are given to patients with a hematological malignancy to prevent or treat bleeding complications. The adhered transfusion trigger for patients with an... Show moreThe majority of platelet transfusions are given to patients with a hematological malignancy to prevent or treat bleeding complications. The adhered transfusion trigger for patients with an increased risk of bleeding varies among hematologists. Although almost 20.000 donors are HLA typed in the Netherlands, adequate transfusion support cannot be guaranteed for all immunized patients, especially not for patients from a non-Caucasian background. From a clinical perspective, major hemorrhage is the most relevant outcome to measure effectiveness of platelet transfusions. We developed a model consisting of drop in hemoglobin, transfusion support, and CT-brain to enable the identification of major hemorrhage among leukemic patients in routinely recorded data. In the Netherlands, the standard platelet concentrate is derived from buffy coats and resuspended in plasma or platelet additive solution (PAS) and can be stored for seven days. Storage has a negative effect on safety and efficacy of platelet transfusions. Using routinely collected health care data, we demonstrated a lower risk of a positive blood culture after transfusion of platelet concentrates stored for five to seven days. Using the database of TRIP, we showed an increased risk of transfusion transmitted bacterial infections for platelet concentrates stored in PAS compared to those stored in plasma. Show less
According to current guidelines, patients with thrombocytopenia due to myelosuppression are supported with platelet concentrates in order to prevent and treat bleeding complications using... Show moreAccording to current guidelines, patients with thrombocytopenia due to myelosuppression are supported with platelet concentrates in order to prevent and treat bleeding complications using algorithms which include the level of thrombocytopenia as well as varying clinical parameters, e.g. concomitant infection, the use of anticoagulant drugs, specific interventions. In the last three decades, mainly driven by safety issues, several platelet product changes were made with leukoreduction in the eighties of the previous century, plasma reduction and the use of additive solution in the nineties and the use of pathogen reduction in the first decade of this century.This thesis is mainly based on two randomised controlled trials testing the clinical efficacy of the use of additive solutions and pathogen reduction, essentially showing a decreased clinical efficacy as well as a decrease in adverse transfusion events. A bette r understanding of the pathophysiology of bleeding, thrombocytopenia and platelet transfusion refractoriness will lead to improvements in supportive care as well as patient survival, the common goal of all physicians. Show less
