Prophylactic platelet transfusions: should they be a treatment of the past?

For decades, prophylactic platelet transfusions have been a standard practice for treatment-related thrombocytopenia in patients with hematologic malignancies, although evidence supporting this practice was limited. Two recent randomized controlled studies were carried out to challenge this practice by comparing prophylactic to therapeutic-only platelet transfusion strategies. This review compares and contrasts the study findings to provide further insight into the study conclusions and their application to practice.

Past studies exploring platelet transfusion in this patient population focused on identifying the optimal platelet threshold for transfusions and the minimum effective dose to achieve hemostasis. Balancing increased demand with limited supply has further necessitated determining if a therapeutic-only approach is as efficacious. This is especially pertinent given improved prognosis of hematologic malignancies because of novel therapies and better diagnostic technologies. Two large randomized controlled studies showed that therapeutic-only strategy reduces platelet utilization, but possibly at an increased risk of high-grade bleeding in certain patient groups.

The majority of this adult patient population should continue to receive prophylactic platelet transfusions to prevent high-grade bleeding. Stable autologous stem cell transplant patients appear to be at a lower risk of thrombocytopenia-related bleeding and are candidates for therapeutic-only platelet transfusions in expert centers with careful monitoring.