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van Baarle FLF, van de Weerdt EK, van der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, van den Bergh WM, Demandt AMP, Kerver ED, Jansen AJG, Westerweel PE, Arbous SM, Determann RM, van Mook WNKA, Koeman M, Mäkelburg ABU, van Lienden KP, Binnekade JM, Biemond BJ, Vlaar APJ. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med 2023; 388:1956-1965. [PMID: 37224197 DOI: 10.1056/nejmoa2214322] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Transfusion guidelines regarding platelet-count thresholds before the placement of a central venous catheter (CVC) offer conflicting recommendations because of a lack of good-quality evidence. The routine use of ultrasound guidance has decreased CVC-related bleeding complications. METHODS In a multicenter, randomized, controlled, noninferiority trial, we randomly assigned patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per cubic millimeter) who were being treated on the hematology ward or in the intensive care unit to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The primary outcome was catheter-related bleeding of grade 2 to 4; a key secondary outcome was grade 3 or 4 bleeding. The noninferiority margin was an upper boundary of the 90% confidence interval of 3.5 for the relative risk. RESULTS We included 373 episodes of CVC placement involving 338 patients in the per-protocol primary analysis. Catheter-related bleeding of grade 2 to 4 occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, 2.45; 90% confidence interval [CI], 1.27 to 4.70). Catheter-related bleeding of grade 3 or 4 occurred in 4 of 188 patients (2.1%) in the transfusion group and in 9 of 185 patients (4.9%) in the no-transfusion group (relative risk, 2.43; 95% CI, 0.75 to 7.93). A total of 15 adverse events were observed; of these events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group and 9 in the no-transfusion group]) were categorized as serious. The net savings of withholding prophylactic platelet transfusion before CVC placement was $410 per catheter placement. CONCLUSIONS The withholding of prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion. (Funded by ZonMw; PACER Dutch Trial Register number, NL5534.).
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Affiliation(s)
- Floor L F van Baarle
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emma K van de Weerdt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter J F M van der Velden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Roelof A Ruiterkamp
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Pieter R Tuinman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Paula F Ypma
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter M van den Bergh
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Astrid M P Demandt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emile D Kerver
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - A J Gerard Jansen
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Peter E Westerweel
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Sesmu M Arbous
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Rogier M Determann
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walther N K A van Mook
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Mirelle Koeman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Anja B U Mäkelburg
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Krijn P van Lienden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Jan M Binnekade
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Bart J Biemond
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Alexander P J Vlaar
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
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9
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Valsami S, Pouliakis A, Gavalaki M, Argyrou A, Triantafillou E, Arvanitopoulou E, Girtovitis F, Voulgaridou V, Megalou A, Chronopoulou P, Papachronis A, Sakellarakis G, Zervou E, Batsi C, Fountouli K, Athanasopoulos A, Kyriakou E, Cheropoulou A, Livada A, Lebessopoulos K, Papakonstantinou M, Gafou A, Katopi D, Martinis G, Dendrinou I, Katharopoulou H, Politou M, Papadopoulou M, Papadopoulou P, Manaka E, Paneta K, Alepi C, Damaskos C, Garmpis N, Stamoulis K, Grouzi E. Platelets transfusion in Greece: Where, when, why? A national survey. Asian J Transfus Sci 2020; 14:158-166. [PMID: 33767543 PMCID: PMC7983137 DOI: 10.4103/ajts.ajts_72_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/02/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Platelet transfusion is among the most useful therapeutic tools in modern clinical settings which mean that ensuring an adequate supply is of paramount importance. AIM The aim of our study was to record the use and wastage of platelet concentrates (PCs) in Greece, so as to come up with evidence-based interventions. METHODS The study was conducted during May and June 2015. We evaluated the use of random-donor platelets (RDPs) and single-donor apheresis platelets (SDPs). We analyzed such parameters as hospital department and diagnosis, indication for transfusion, PCs' age at the time of transfusion, and wastage rate. RESULTS We used data from 21 hospitals across the country. A total of 12,061 RDPs and 1189 SDPs were transfused, with an average of 4.84 (±2.72) and 1.12 (±2.73) units per episode, respectively. Most patients had been admitted to the internal medicine and hematology departments. The transfusions were mostly given prophylactically, usually in cases of acute leukemia, and mostly on the day before expiration. Wastage rate was 16.75% for RPDs and 2.70% for SDPs, primarily because of the expiration of the use-by date. CONCLUSIONS This is the first national survey regarding platelet transfusion in Greece. Since most patients were admitted in internal medicine and hematology departments, we recommend that the staff of the abovementioned departments should undergo training on contemporary transfusion guidelines. Platelet discard rate could further be lowered through the centralization of inventory management along with the extension of the lifetime of PCs by means of emerging technologies.
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Affiliation(s)
- Serena Valsami
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, National and Kapodistrian University of Athens, “Attikon” University Hospital, Patras, Greece
| | - Maria Gavalaki
- Department of Blood Transfusion, Laiko General Hospital, Patras, Greece
| | - Aspasia Argyrou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | | | | | - Fotios Girtovitis
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Virginia Voulgaridou
- Department of Blood Transfusion, AHEPA, University Hospital of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Megalou
- Department of Blood Transfusion, Evangelismos Hospital, Patras, Greece
| | | | | | | | - Eleftheria Zervou
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Christina Batsi
- Department of Blood Transfusion, University Hospital of Ioannina, Ioannina, Greece
| | - Kalliopi Fountouli
- Department of Blood Transfusion, University Hospital of Heraklion, Heraklion, Greece
| | | | - Elias Kyriakou
- Laboratory of Hematology and Blood Bank Unit, “Attikon” University Hospital, National and Kapodistrian Athens, Patras, Greece
| | | | - Anastasia Livada
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
| | | | | | - Anthi Gafou
- Department of Blood Transfusion, “Saints Anargyroi” Hospital, Patras, Greece
| | - Despina Katopi
- Department of Blood Transfusion, General Hospital Alexandra, Patras, Greece
| | - George Martinis
- Department of Blood Transfusion, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioanna Dendrinou
- Department of Blood Transfusion, General Hospital Nea Ionia “Agia Olga”, Patras, Greece
| | - Hrysanthi Katharopoulou
- Department of Blood Transfusion, “Hatzikosta” General Hospital of Ioannina, Ioannina, Greece
| | - Marianna Politou
- Hematology, Laboratory-Blood Bank Department, Aretaieion Hospital, National and Kapodistrian University of Athens, Medical School, Patras, Greece
| | | | | | - Ekaterini Manaka
- Department of Blood Transfusion, General Hospital of Messologgi, Messologgi, Greece
| | - Konstantina Paneta
- Department of Blood Transfusion, General Hospital of Pirgos, Pirgos, Greece
| | - Chrissoula Alepi
- Department of Blood Transfusion, General Hospital “Tzaneio” of Piraeus, Patras, Greece
| | - Christos Damaskos
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery,“Medical School, Laiko” General Hospital, National and Kapodistrian University of Athens, Patras, Greece
| | | | - Elisavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, “Saint Savvas” Oncology Hospital of Athens, Patras, Greece
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