Prophylactic half-dose platelet transfusion effect on thrombocytopenia, transfusion, and bleeding occurrence in patients with hematologic disease

OBJECTIVES: To provide the lowest effective dose and minimize toxicity, our transfusion service initiated the use of a half-dose for all prophylactic inpatient platelet transfusions. The main rationale for this change in dose was the lack of evidence of increased bleeding and mortality in lower-dose platelet transfusion. Since the current platelet dose is not evidence based, and dose and toxicity are linked for most therapeutics, this approach to reducing adverse effects made scientific and clinical sense. In addition, many blood centers have experienced platelet shortages. METHODS: This retrospective study included nonbleeding patients older than 50 years with a diagnosed hematologic disease who received prophylactic platelet transfusions and were admitted to our inpatient cancer center between November 1, 2023, and January 1, 2024. RESULTS: Significantly lower volumes of platelets (153 vs 313 mL, P < .0001; 95% CI, 153-166) were administered to the study cohort (n = 310) vs the control (n = 301). No significant differences were seen in the number of transfusion events per hospitalization of platelets (4.4 vs 4.1, P = .7; 95% CI, -2.2 to 1.5) and red blood cells (5.9 vs 7.5, P = .29; 95% CI, -1.4 to 4.7). The mean platelet counts were similar between both groups in pretransfusion (10.3 vs 10 × 109/L, P = .73; 95% CI, -1.8 to 1.3) and posttransfusion (13.8 vs 15.9 × 109/L, P = .16; 95% CI, -0.88 to 5.1). Bleeding event frequency was also similar between both groups (1.6% vs 1.3%, respectively). CONCLUSIONS: Half-dose platelets appear to be safe and effective in nonbleeding patients receiving prophylactic transfusions. This strategy reduces patient exposure to potentially harmful higher-dose transfusions without increasing bleeding events or red blood cell transfusions.