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Habr B, Charpentier J, Champigneulle B, et al. Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit. Ann Intensive Care. 2015;5(1):46doi: 10.1186/s13613-015-0088-2.
Habr, B., Charpentier, J., Champigneulle, B., Dechartres, A., Daviaud, F., Geri, G., Cariou, A., Chiche, J. D., Mira, J. P., & Pène, F. (2015). Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit. Annals of intensive care, 5(1), 46. https://doi.org/10.1186/s13613-015-0088-2
Habr, Bassem, et al. "Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit." Annals of intensive care vol. 5,1 (2015): 46. doi: https://doi.org/10.1186/s13613-015-0088-2
Habr B, Charpentier J, Champigneulle B, Dechartres A, Daviaud F, Geri G, Cariou A, Chiche JD, Mira JP, Pène F. Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit. Ann Intensive Care. 2015 Dec;5(1):46. doi: 10.1186/s13613-015-0088-2. Epub 2015 Dec 01. PMID: 26621198; PMCID: PMC4666191.
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Ann Intensive Care. 2015 Dec;5(1):46. doi: 10.1186/s13613-015-0088-2. Epub 2015 Dec 01.

Platelet transfusions in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit.

Annals of intensive care

Bassem Habr, Julien Charpentier, Benoît Champigneulle, Agnès Dechartres, Fabrice Daviaud, Guillaume Geri, Alain Cariou, Jean-Daniel Chiche, Jean-Paul Mira, Frédéric Pène

Affiliations

  1. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  2. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  3. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  4. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  5. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  6. Centre d'épidémiologie et de recherche clinique, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France. [email protected].
  7. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  8. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  9. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  10. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  11. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  12. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  13. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  14. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  15. Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. [email protected].
  16. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  17. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  18. Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. [email protected].
  19. Réanimation Médicale, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France. [email protected].
  20. Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. [email protected].
  21. Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France. [email protected].

PMID: 26621198 PMCID: PMC4666191 DOI: 10.1186/s13613-015-0088-2

Abstract

BACKGROUND: Thrombocytopenia is a frequent finding in critically ill cancer patients for whom indications of platelet transfusions are unclear. We herein addressed the current practices in platelet transfusion and the risk of bleeding in cancer patients with hypoproliferative thrombocytopenia in the intensive care unit (ICU).

METHODS: A retrospective monocenter study over a 7-year period was conducted in a medical ICU. Adult patients with malignancies and hypoproliferative thrombocytopenia, and who received at least one platelet concentrate during their ICU stay, were included.

RESULTS: 296 patients were included and received a total of 904 platelet transfusions, for prophylactic indications in 300 (33.2 %) episodes, for securing an invasive procedure in 257 (28.4 %), and for treatment of minor to major bleeding manifestations in 347 (38.4 %). Most prophylactic transfusions (80 %) were performed at platelet count thresholds below 10-20 × 10(9)/L. Platelet increments were generally low in all three indications, 10 (interquartile range 2-25), 11 (2-25), and 8 (0-21) × 10(9)/L, respectively. A total of 97 major ICU-acquired bleeding events occurred in 40 patients. About half of those bleeding episodes (54.7 %) occurred at platelet counts below 20 × 10(9)/L. However, neither low admission platelet count nor low nadir platelet counts were predictive of ICU-acquired bleeding. The in-ICU mortality rate tended to be higher in patients with severe ICU-acquired bleeding events (50 vs. 36 %).

CONCLUSIONS: Most prophylactic platelet transfusions were given using thresholds of 10-20 × 10(9)/L in critically ill thrombocytopenic cancer patients. The individual risk of ICU-acquired severe bleeding appears hardly predictable with the depth of thrombocytopenia.

Keywords: Bleeding; Cancer; Intensive care unit; Thrombocytopenia; Transfusion

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