[Practice assessment in platelet transfusions]

Platelet transfusion follows the national guidelines published in 2003 by the AFSSAPS, determining, for instance, indications, transfusion threshold and platelets dose. We wanted to assess how these guidelines are routinely used in our hospital, with a special focus on transfusion threshold and delivered dose.

We conducted a prospective study during 11 months on every platelet transfusion. Our establishment is a medium size structure, devoted to emergency and oncology, without bone marrow transplantation. During this period, 235 products were delivered to 105 patients. Half (52%) were delivered to oncological units, a third to emergency units and the remaining to medical and surgical units.

The average dose was 4.3±0.8×10(11) platelets (2.0 to 7.6×10(11) platelets), corresponding to 0.45×10(11) platelets per 7kg. During prophylactic transfusions, the average platelet count was 9.4±5.5G/L ; during curative transfusions (43%), it was 39.0±47.8G/L and finally when platelets were infused during surgery (21%), the average platelet count was 57.8±61.4G/L.

Globally, with regard to transfusion threshold, guidelines were followed in 71%, and 93% in oncological units. Transfusion efficacy, attested by post-transfusion platelet efficiency was above 20% in 59% of the cases. These data highlight a good respect of the transfusion thresholds in the usual platelets-consuming units, but raise the question of the dose, often under those proposed by the guidelines.