Platelet transfusion: Experience of the gastro-enterology departement

Charles Nicolle Hospital

BEN SAID M , SAID Y , BAHLOUL A , NAJJAR T , GUERMAZI S

Introduction:Introduction: Platelet transfusion: complex act needing the Platelet transfusion: complex act needing the

consideration of several factors.consideration of several factors.

Platelet transfusion in patients with acute or Platelet transfusion in patients with acute or chronic liver disease:chronic liver disease:

Curative: active bleedingCurative: active bleeding Preventive: biopsy, embolization….Preventive: biopsy, embolization….

Objective: we report in this work our experience with platelet transfusion in this particular situation.

Patients & Methods:Patients & Methods:

Retrospective study: October 2007 → Retrospective study: October 2007 → February 2012.February 2012.

A fact sheet was designed to collect:A fact sheet was designed to collect:

Indication

Epidemiological data

Clinical and hematological data

Transfusion

16 patients: 16 patients:

Mean age Sex-ratio M/F Number of transfusion

episodes

53 years [15-73] 1,6 20

RESULTSRESULTS

Curative platelets transfusion:Curative platelets transfusion:

Causes:Causes:

Central: Peripheral:-Bone marrow aplasia-Bone marrow metastases

-Disseminated intravascular coagulation-Hypersplenism

Efficiency criteria:Efficiency criteria: Increase of Plt-count > 20 %Increase of Plt-count > 20 % Stop of bleedingStop of bleeding

A clinical response associated with an

efficient transfusion

Failure: 2/7 patients

5/7 patients Causes:s: -The severity of thrombocytopenia. - An important hypersplenism.

Preventive platelets transfusion:Preventive platelets transfusion:

9 patients (55%): Cirrhosis with 9 patients (55%): Cirrhosis with hypersplenism:hypersplenism:

Indications: Indications:

Before:Before:- Liver biopsy

- Chemo embolization (adeno K)

- Polypectomy…

• Associated with thrombocytopenia (<50G / L or <100 G/ L if age> 70 years).• Prothrombin time was <50% in 88% of cases

Efficiency of transfusion:Efficiency of transfusion:

82 % of cases:82 % of cases:

→ → the different acts were held without the different acts were held without incidents.incidents.

18 % of cases:18 % of cases:

HypersplenismHypersplenism Insufficient amount of SPCInsufficient amount of SPC

Increase of Plt Count > 20 % (+) no bleeding:

Failure:

Comments (1)Comments (1)

Thrombocytopenia in patients with Thrombocytopenia in patients with hepatopathies are related to: hepatopathies are related to: --hypersplenismhypersplenism

-viral etiology of cirrhosis or hepatitis-viral etiology of cirrhosis or hepatitis

-central origin-central origin

Risk of bleeding is majorated by low Risk of bleeding is majorated by low prothrombin timeprothrombin time

Comments (2):Comments (2):

Efficiency of platelet transfusion is limited by Efficiency of platelet transfusion is limited by hypersplenismhypersplenism

The failure of curative transfusion of platelets The failure of curative transfusion of platelets is observed in patients with severe is observed in patients with severe thrombopenia, DIC thrombopenia, DIC

The minimal platelet count needed in The minimal platelet count needed in prophylatic transfusion is no well established.prophylatic transfusion is no well established.

Conclusion:Conclusion:

Curative and preventive transfusion of Curative and preventive transfusion of platelets are not well codified in platelets are not well codified in patients with hepatopathies.patients with hepatopathies.

Prospective studies are needed to Prospective studies are needed to establish guidelines.establish guidelines.