2023-05-30 12:00:23
Further restraint in giving preventive blood platelet transfusions is not wise in all cases
In recent years, the number of patients receiving a blood transfusion during an ICU admission has halved. The side effects of blood transfusions and the increasing scarcity and costs of blood products have led to a trend towards becoming more and more reluctant to transfuse blood products. For the first time, researchers from Amsterdam UMC, in collaboration with researchers from eight other Dutch hospitals, have shown that further restraint in giving preventive blood platelet transfusions is not wise in all cases.
The research, led by Amsterdam UMC, is a collaboration between intensivists and haematologists, professional groups that often have to deal with issues related to blood transfusions. One of these issues was the focus of the research. Lead researcher and head of the ICU Alexander Vlaar: “In the ICU, more than half of the patients receive a central venous line (CVL, an IV that is inserted into a large blood vessel) for the administration of medication or for dialysis. But what do you do when patients need a CVL and they have a shortage of platelets, which causes clotting problems and increases the tendency to bleed?”
Different outcome than expected
To prevent possible bleeding, the answer used to be: give a platelet transfusion. Platelets ensure that the blood can clot. In recent years, however, the question has been increasingly asked in healthcare whether a platelet transfusion is really necessary to safely insert a CVL. According to the guidelines, the limit value of the number of platelets per liter of blood for giving a platelet transfusion prior to placing a CVL has been more than halved in the past ten years. Vlaar: “We therefore entered this study with the expectation that, just as in other situations for which this was already known, we could safely omit a platelet transfusion altogether. But the outcome was different. Patients with very few platelets actually have less bleeding if they are transfused prior to CVL placement.”
Stay critical
According to the researchers, the outcome of this study does not immediately mean that all patients will have to undergo a platelet transfusion as a precaution, but it does show that any possible cost savings should always be properly investigated. Physician-researcher Floor van Baarle: “If we had not further investigated this internationally deployed policy, doctors would simply continue to follow this policy of being increasingly cautious in the future. But we must remain critical and, as doctors, continue to ask ourselves what risk we consider acceptable in cost savings.”
Successful collaboration of disciplines
A CVL is also often used in the treatment of hematology patients, but patients with hematological disorders have a completely different cause of the low platelet count than patients in the Intensive Care Unit. “In hematology patients, the production of platelets is disrupted due to the disease or chemotherapy. Most ICU patients produce platelets, but these are used up immediately. Our study shows that placing a CVL without a platelet transfusion as a precaution leads to more bleeding in haematological patients than in ICU patients,” said lead researcher and haematologist Bart Biemond. “The beauty of this research is that two different disciplines have successfully collaborated, hematologists and intensivists. As a result, we can see in this study that the cost-benefit assessment can work out differently for different patients, and that is very valuable information.”
The results of this ZonMW-funded study were published May 25 in the New England Journal of Medicine
Bron: Amsterdam UMC
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