Fundamentals of Platelet and Granulocyte Support in Myelosuppressed Leukemia and Bone Marrow Transplant Patients
The basic objective of platelet replacement is to provide hemostasis for patients with inadequate bone marrow function who are at risk for major and/or fatal hemorrhage from thrombocytopenia. The degree of physiologic deficit generally accepted to correlate with an increased risk of hemorrhage is a peripheral blood platelet concentration < 20x109/l. In general, a normal template bleeding time is believed to reflect in vivo hemostasis. The fundamental task would appear to be to: 1) establish the relationship between peripheral blood platelet concentration and a normal bleeding time; and 2) define the total dose of cells required to achieve this concentration. The intravascular survival of the transfused platelets would then determine the frequency of replacement and the duration of myeolosuppression would define the total number of transfusions required. However, biologic systems do not lend themselves to such simple solutions and complications in interpretation of transfusion results occur from numerous patient and component variables. Transfusion response is altered by numerous clinical variables which may occur as single events or combinations of events. Issues related to the component include the selection of pooled units of platelet concentrates versus single donor, and fresh versus stored platelets. Issues relating to granulocyte concentrates include all those enumerated for platelet replacement, but introduce unresolved questions of identifying patients whose infections will not be controlled by antibiotics alone and defining response criteria.
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