Refractory Thrombocytopenia is a Valid Early Diagnostic Criteria for Hepatic Veno-Occlusive Disease in Children
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
We compared the incidence of refractory thrombocytopenia (RT) and platelet transfusion requirements (PTR) in 35 children who developed VOD with 35 matched controls who underwent HSCT but did not develop VOD. RT developed in 100% of the VOD patients, at a median of 8 days before VOD diagnosis, as compared to 71.5% of the control group. VOD patients required more platelets transfusions than controls (median PTR 6.9 ml/kg (range: 0.57-17.59) vs. 3.57 ml/kg (range: 0-14.63) in the control group with the difference being statistically significant (P < 0.0001). Numbers of days with platelet requirement, were significantly higher for VOD patients as compared to controls, (median % of days 68% vs. 39%, P=< .0001). The PTR peaked at approximately 12 mL/kg/day, 2 days before VOD diagnosis, whereas the PTR in the control population was 5 mL/kg/day. The positive predictive value (PPV) of developing VOD was 88.9% (95% CI: 66.5-97%) in patients who were given >7ml/kg/day of platelets during at risk period of days +3 to +13 after transplant. For patients who got >8ml/kg/day pf platelets, the PPV of developing VOD was 86.7% (95%CI: 61.2 -96.4%). There was no difference in the PTR in patients with mild to moderate VOD as compared to those with severe VOD, however PTR was higher in patients whose VOD did not resolve. The median, average, daily PTR after the diagnosis of VOD in 17 patients who got defibrotide as compared to those who did not get defibrotide was 6.04 ml/kg and 5.72 ml/kg respectively and the difference was not statistically significant (p=0.56). On univariate and multivariate analysis use of intravenous immunoglobulin (IVIG) was significantly associated with VOD (p=0.0088), however use of IVIG was not significantly associated with fatal VOD. In conclusion RT occurs in 100% of patients at a median of 8 days before VOD diagnosis. VOD should be suspected in any patient with RT after the exclusion of other causes of consumptive thrombocytopenia especially if they are needing >7ml/kg/day of platelets.
The association between platelet transfusion and idiopathic pneumonia syndrome is unaffected by platelet product type
BACKGROUND Methods used to produce platelet (PLT) components, pooling of PLT-rich plasma (PRP-PLT) and apheresis (AP-PLT), may variably contribute to the pathogenesis and severity of idiopathic pneumonia syndrome (IPS). STUDY DESIGN AND METHODS We performed a retrospective cohort study of 906 allogeneic hematopoietic cell transplant recipients to examine associations between PLT product type and risks of developing IPS and dying after IPS onset. Proportional hazards models included separate terms for the sum of all PLT transfusions and the sum of PRP-PLT units received in the 3 or 7 days before IPS onset. Similarly constructed models analyzed the outcome of time to death after IPS onset. All analyses were adjusted for known IPS risk factors. RESULTS Patients received a median of three PRP-PLT transfusions (interquartile range [IQR], 0-6) and five AP-PLT transfusions (IQR, 1-13) while at risk for IPS. Seventy-five patients (8%) developed IPS by Posttransplant Day 120. The proportion of PRP-PLT transfusions was not associated with risk of developing IPS (3-day hazard ratio [HR] 0.98, 95% CI 0.74-1.29, p=0.86; 7-day HR 1.00, 95% CI 0.86-1.15, p=0.95) or dying after IPS onset (3-day HR 0.99, 95% CI 0.75-1.31, p=0.97; 7-day HR 0.98, 95% CI 0.78-1.12, p=0.47). CONCLUSION The association between PLT transfusions and risk of developing IPS or dying after IPS onset does not differ according to PLT product type. Further research is required to identify potentially modifiable steps in PLT component production that contribute to IPS. Copyright © 2015 AABB.