CLINICAL AND TRANSFUSION RELATED FACTORS INFLUENCING POST-TRANSFUSION PLATELET RESPONSE AMONG THROMBO-CYTOPENIC PATIENTS IN MALAYSIA.

Mohd Zamri MOHD HAYAT¹, Mohd Nazri HASSAN^{1, 2}, Suhair ABBAS AHMED¹, Noor Haslina MOHD NOOR^{1, 2}, Marini RAMLI^1,2, Zefarina ZULKAFLI^{1, 2}, Wan Suriana WAN AB RAHMAN³, Shafini MOHAMED YUSOFF ^{1 ,2}.

¹Department of Hematology, School of Medical Sciences, ²Hospital USM, Health Campus, and ³School of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia.

ABSTRACT

Introduction: Most clinicians are inclined to request platelet transfusion for thrombocytopenic patients with bleeding or at high risk of bleeding. Many factors that may influence post-transfusion platelet increments have been proposed, but the specific prediction of increment for each patient is quite difficult. Hence, this study was carried out to determine the factors that may influence post-transfusion platelet increment in thrombocytopenic patients. Methods: This is a retrospective review of 97 thrombocytopenic patients who received a total number of 351 platelet transfusions over a period of two years. The clinical and transfusion related factors were evaluated based on post-transfusion platelet response measured by corrected count increment (CCI) calculated at one and 24 hours post-transfusion. Simple logistic regression and multiple logistic regression tests were used for statistical analyses and p values of <0.05 were considered significant. Results: The mean age of patients were 42.6±20.8 years and the majority were Malays (92.8%). Patients diagnosed with malignancies constitutes 63.9% of the total subjects and 66.1% had good CCI with mean CCI of 15.8x10⁹/L. The predictive factors of poor CCI were disseminated intravascular coagulopathy (DIC) (adjusted OR=5.31; CI=3.06, 9.24; p<0.001) and platelet shelf age of  ≥4 days (adjusted OR=2.2; CI=1.29, 3.75; p=0.004). Conclusion: DIC and older platelet shelf age gave inferior post-transfusion platelet response. Thus, fresh platelet concentrates (≤3 days) are highly recommended in thrombocytopenic patients as they showed better post-transfusion platelet response.

Keywords: ABO blood-group system, Disseminated intravascular coagulation, Platelet, Platelet transfusion, Thrombocytopenia.

Corresponding author: Dr Mohd Nazri Hassan, MPath (Haematology) Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia; E-mail: nazrihas@usm.my; Tel: +06097676198; Fax: +609-7673333.

Brunei Int Med J. 2019;15:145-152