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Platelet transfusions administered to patients with splenomegaly
M A Hussein1, E J Lee, C A Schiffer
1Division of Hematologic Malignancies, University of Maryland Cancer Center, Baltimore.
Transfusion
|July 1, 1990
Summary
Platelet transfusions in patients with splenomegaly can be effective, even with significant spleen enlargement. Many patients still achieve clinically helpful platelet count increments, indicating splenomegaly does not always preclude successful treatment.
Area of Science:
- Hematology
- Transfusion Medicine
Background:
- Splenic sequestration is thought to reduce platelet count increments after transfusion in patients with splenomegaly.
- The impact of spleen size on platelet transfusion efficacy requires further investigation.
Purpose of the Study:
- To analyze the effect of splenomegaly on corrected count increments (CCIs) and platelet survival after random-donor platelet transfusions.
- To determine if splenomegaly should be a contraindication for intensive platelet transfusion therapy.
Main Methods:
- Analysis of 631 platelet transfusions in 66 thrombocytopenic patients with palpable splenomegaly.
- Evaluation of corrected count increments (CCIs) and platelet survival based on spleen size (cm below left costal margin).
Main Results:
- Increasing splenomegaly significantly reduced CCIs, with the most pronounced effect in spleens >2.0 cm below the costal margin.
- Despite splenomegaly, 42% of transfusions yielded CCIs >7500, with many providing clinically beneficial increments.
- Platelet survival was reduced in splenomegaly patients, indicated by a lower 24-hour to 1-hour CCI ratio compared to expected values.
Conclusions:
- A significant proportion of patients with splenomegaly can benefit from platelet transfusions.
- Splenomegaly should not be a reason to withhold intensive therapeutic approaches involving platelet transfusions.