Clinical Strategies for the Prevention of Platelet Alloimmunization

Abstract

The use of platelets for transfusion has increased dramatically over the past 20 years since the use of chemotherapy has become a routine treatment for patients with cancer. Within the most recent decade, the application of bone marrow transplantation to many malignancies not previously treated with this modality, and the identification and production of large quantities of human cytokines have resulted in larger numbers of patients receiving higher doses of chemotherapy. Although the cytokines currently used are potent stimulants of granulocytopoiesis and erythropoiesis, none yet discovered has been shown to stimulate production of platelets. A recent study that evaluated patterns in blood transfusion in the United States between 1982 and 1988 found that the number of red blood cell units transfused has remained the same. Over the same interval, there was a 50% increase in the number of units of platelets transfused. Indeed, the use of platelets obtained from a single donor by apheresis has grown even more rapidly, increasing from 16.8% of all platelet transfusions in 1982 to 24.6% in 1987 [1]. It seems likely that the usage of platelets will continue to increase.