The effect of therapeutic (for grade 2 bleeding) compared to prophylactic (for platelet count less than 10,000/mm3) platelet transfusions was studied in 391 adult patients undergoing myeloablative chemotherapy for acute myeloid leukemia (AML) or autologous stem cell transplantation for hematologic malignancies.

The therapeutic platelet transfusion strategy reduced mean number of platelet transfusions by 33.5%. In the cohort receiving therapeutic platelet transfusions, no increased risk of major hemorrhage was found in the autologous transplant group; however, patients with AML had an increased risk of CNS bleeding.

The authors conclude that therapeutic platelet transfusions could represent best practices after autologous stem cell transplantation; however, prophylactic platelet transfusions should remain the standard for patients with AML.

– Lawrence Tim Goodnough