http://caprockhematology.com/Site/AML_and_ALL_files/AML%20Review%20Blood%202010.pdf

Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet.

Disseminated intravascular coagulation is characterized by the widespread activation of coagulation, which results in the intravascular formation of fibrin and ultimately thrombotic occlusion of small and midsize vessels.1–3 Intravascular coagulation can also compromise the blood supply to organs and, in conjunction with hemodynamic and metabolic derangements, may contribute to the failure of multiple organs. At the same time, the use and subsequent depletion of platelets and coagulation proteins resulting from the ongoing coagulation may induce severe bleeding (Figure 1). Bleeding may be the presenting symptom in a patient with disseminated intravascular coagulation, a factor that can complicate decisions about . . .

Disseminated Intravascular Coagulation

Platelet transfusions are administered to prevent or treat bleeding in patients with quantitative or qualitative platelet disorders The AABB (formerly, the American Association of Blood Banks) dev

/pdf/platelet-transfusion-a-clinical-practice-guideline-from-the-z49w3rb37w.pdf

Platelet Transfusion: A Clinical Practice Guideline From the AABB

Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet

Objective: To determine the most effective, evi- dence-based approach to the use of platelet transfu- sions in patients with cancer. Outcomes: Outcomes of interest included prevention of morbidity and mortality from hemorrhage, effects on survival, quality of life, toxicity reduction, and cost-effectiveness. Evidence: A complete MedLine search was per- formed of the past 20 years of the medical literature. Keywords included platelet transfusion, alloimmuniza- tion, hemorrhage, threshold and thrombocytopenia. The search was broadened by articles from the bibliog- raphies of selected articles. Values: Levels of evidence and guideline grades were rated by a standard process. More weight was given to studies that tested a hypothesis directly related to one of the primary outcomes in a randomized design. Benefits/Harms/Cost: The possible consequences of different approaches to the use of platelet transfusion were considered in evaluating a preference for one or another technique producing similar outcomes. Cost alone was not a determining factor. Recommendations: Appendix A summarizes the rec- ommendations concerning the choice of particular platelet preparations, the use of prophylactic platelet transfusions, indications for transfusion in selected clin- ical situations, and the diagnosis, prevention, and man- agement of refractoriness to platelet transfusion. Validation: Five outside reviewers, the ASCO Health Services Research Committee, and the ASCO Board re- viewed this document. Sponsor: American Society of Clinical Oncology J Clin Oncol 19:1519-1538. © 2001 by American Society of Clinical Oncology. INTENSIVE THERAPIES producing severe and sus- tained thrombocytopenia are used routinely in patients with hematologic malignancies and are being applied to many patients with solid tumors as well. Advances in platelet collection, storage, and transfusion have decreased the morbidity of such therapies, and death from hemorrhage is now an unusual occurrence, despite the larger number of patients being treated aggressively. Platelet transfusions are expensive, however, and are associated with a number of side effects including febrile or allergic transfusion reac- tions, transmission of bacterial and viral infections, circu- latory congestion, transfusion-related acute lung injury and alloimmunization. The ASCO Health Services Research Committee elected to convene an Expert Panel to design guidelines for platelet transfusion because of perceived wide variation in platelet transfusion practices. This paper will first describe the types of platelet products available for transfusion and then provide evidence-based guidelines for use in different clinical situations.

Platelet Transfusion for Patients With Cancer: Clinical Practice Guidelines of the American Society of Clinical Oncology*

Background Prophylactic platelet transfusions are usually administered to patients receiving myelotoxic chemotherapy when their platelet count falls below 20,000 per cubic millimeter. Some observations suggest that lower platelet counts can be appropriate in patients in stable condition, but the safety of lower thresholds is uncertain. Methods We evaluated 255 adolescents and adults (age, 16 to 70 years) with newly diagnosed acute myeloid leukemia (but not acute promyelocytic leukemia), who were treated in 21 centers. One hundred thirty-five patients were randomly assigned to receive a transfusion when their platelet count fell below 10,000 per cubic millimeter (or 10,000 to 20,000 per cubic millimeter in those with a temperature above 38°C, with active bleeding, or a need for invasive procedures), and 120 patients were assigned to receive a transfusion when their platelet count was less than 20,000 per cubic millimeter. Results Patients in the group with a threshold of 10,000 platelets per cubic millimet...

https://www.nejm.org/doi/pdf/10.1056/NEJM199712253372602

The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto

White cell‐reduced red cells prepared by filtration: a critical evaluation of current filters and methods for counting residual white cells

Platelet concentrates prepared from pooled buffy coats (BCPC) were stored in Plasma-Lyte A, a glucose-free synthetic medium, after leukocyte depletion by filtration through Pall PL 50, and compared to paired unfiltered BCPC stored in the same medium. Each pair of BCPC units was prepared from a pool of 10 buffy coats split into two identical units. Platelet and leukocyte counts per unit of BCPC were 2.70 +/- 0.19 x 10(11) and 3.8 +/- 2.8 x 10(6) (filtered BCPC), 2.59 +/- 0.27 x 10(11) and 79 +/- 56 x 10(6) (control BCPC), respectively. Filtration procedures did not affect in vitro parameters of platelet quality and function such as osmotic reversal, ATP release and aggregation in response to collagen and ADP during 15-day storage. A similar decrease of platelet membrane glycoprotein Ib and a similar rise of activation markers GMP-140, gp 53 and platelet-bound fibrinogen were observed during storage of filtered and control BCPC. Our study indicates that storage of BCPC after filtration is feasible and that a reduction in leukocyte content by filtration to mean cell counts of less than five millions per unit has probably no effect on platelet storage lesion.

F. Marangoni

Papers

The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto

White cell‐reduced red cells prepared by filtration: a critical evaluation of current filters and methods for counting residual white cells

Platelet concentrates stored in synthetic medium after filtration.

Relationship of the time of storage and transfusion reactions to platelet concentrates from buffy coats

Quality control of red cell filtration at the patient's bedside