Thrombocytopenia-Platelet Support or Growth Factors?

The prevention and treatment of hemorrhage in patients with severe thrombocytopenia following cytotoxic chemotherapy and/or radiotherapy remain important issues in the supportive care of these patients. Platelet transfusions have been available for this purpose for over 30 years, and there have been recent initiatives to refine the way in which they are used and to improve their safety. An alternative to platelet transfusions is the enhancement of platelet recovery through the use of hemopoietic growth factors, and the recent identification of thrombopoietin and its potential for clinical use are exciting developments. Further work is needed to ensure its safety, and to define the appropriate indications for its use. Another alternative to platelet transfusions is the use of platelet substitutes, and a number of products are being developed. The clinical use of hemopoietic growth factors and platelet substitutes raises the prospect of reducing the current high demand for platelet concentrates. However, it remains to be seen whether their potential will be fully realised, and platelet transfusions will continue to be needed for the forseeable future.