Risks, costs, and alternatives to platelet transfusions

The use of platelet transfusions has increased greatly in the past decade and is likely to continue to escalate because of the risks of thrombocytopenia in patients receiving dose-intensive cancer chemotherapy, the increased use of hematopoietic progenitor cell transplantation, and the prevalence of human immunodeficiency virus infection. Despite marked advances in procedures for ensuring the safety of platelets, including intensive donor screening, infectious disease marker testing, and increased use of leukodepletion techniques, platelet transfusions carry a significant risk for immunologic disorders and transmission of bacterial, viral, and perhaps other diseases and can entail a very high cost. In addition, thrombocytopenia has the potential to interfere with delivery of chemotherapy on schedule and at the planned doses, thus potentially compromising treatment outcome. The limitations of platelet transfusions have prompted the development of agents with the potential to stimulate platelet production and thus reduce or eliminate the need for transfusions. Two such agents, interleukin-11 (IL-11) and thrombopoietin (TPO), have demonstrated promise in clinical trials. In November, 1997, IL-11 received FDA approval for the prevention of severe thrombocytopenia in high risk patients receiving myelosuppressive chemotherapy. Thrombopoietic growth factors have the potential to greatly simplify and increase the safety of transfusion medicine.