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Related Experiment Video

Updated: Apr 15, 2026

Preparation and Pathogen Inactivation of Double Dose Buffy Coat Platelet Products using the INTERCEPT Blood System
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A no-prophylaxis platelet-transfusion strategy for hematologic cancers.

Simon J Stanworth1, Lise J Estcourt, Gillian Powter

  • 1National Health Service (NHS) Blood and Transplant, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, and Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

The New England Journal of Medicine
|May 10, 2013
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Summary

Prophylactic platelet transfusions are recommended for patients with hematologic cancers to prevent bleeding. Avoiding these transfusions led to more bleeding days and earlier bleeding episodes, despite reduced platelet use.

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Area of Science:

  • Hematology
  • Oncology
  • Transfusion Medicine

Background:

  • The efficacy of prophylactic platelet transfusions in preventing bleeding for patients with hematologic cancers is not well-established.
  • This study aimed to compare the effectiveness and safety of a no-prophylaxis policy versus a prophylactic platelet transfusion policy.

Purpose of the Study:

  • To determine if withholding prophylactic platelet transfusions is as effective and safe as providing them for patients with thrombocytopenia undergoing chemotherapy or stem-cell transplantation.
  • To evaluate bleeding rates and related outcomes in patients with hematologic cancers under different platelet transfusion strategies.

Main Methods:

  • A randomized, open-label, noninferiority trial was conducted across 14 centers in the UK and Australia.
  • Patients aged 16+ with thrombocytopenia (platelet count < 10×10(9)/L) were randomized to receive prophylactic platelet transfusions or not.
  • The primary endpoint was the occurrence of World Health Organization (WHO) grade 2, 3, or 4 bleeding within 30 days of randomization.

Main Results:

  • Bleeding of WHO grade 2, 3, or 4 occurred in 50% of the no-prophylaxis group versus 43% in the prophylaxis group (P=0.06 for noninferiority).
  • The no-prophylaxis group experienced more bleeding days and a shorter time to the first bleeding episode.
  • Platelet utilization was significantly lower in the no-prophylaxis group, with similar bleeding rates in autologous stem-cell transplant subgroups.

Conclusions:

  • The findings support the continued use of prophylactic platelet transfusions to reduce bleeding in patients with hematologic cancers.
  • Despite prophylaxis, a significant proportion of patients experienced bleeding, indicating a need for ongoing research and optimized transfusion strategies.