Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia

Cassandra D. Josephson, Suzanne Granger, Susan F. Assmann, Marta Inés Castillejo, Ronald G. Strauss, Sherrill J. Slichter, Marie E. Steiner, Janna M. Journeycake, Courtney D. Thornburg, James Bussel, Eric F. Grabowski, Ellis J. Neufeld, William Savage, Steven R. Sloan

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Age-group analyses were conducted of patients in the prophylactic platelet dose trial (PLADO), which evaluated the relation between platelet dose per transfusion and bleeding. Hospitalized patients with treatment-induced hypoproliferative thrombocytopenia were randomly assigned to 1 of 3 platelet doses: 1.1 × 10 11, 2.2 × 10 11, or 4.4 × 10 11 platelets/m 2 per transfusion, given for morning counts of ≤ 10 000 platelets/μL. Daily hemostatic assessments were performed. The primary end point (percentage of patients who developed grade 2 or higher World Health Organization bleeding) was evaluated in 198 children (0-18 years) and 1044 adults. Although platelet dose did not predict bleeding for any age group, children overall had a significantly higher risk of grade 2 or higher bleeding than adults (86%, 88%, 77% vs 67% of patients aged 0-5 years, 6-12 years, 13-18 years, vs adults, respectively) and more days with grade 2 or higher bleeding (median, 3 days in each pediatric group vs 1 day in adults; P < .001). The effect of age on bleeding differed by disease treatment category and was most pronounced among autologous transplant recipients. Pediatric subjects were at higher risk of bleeding over a wide range of platelet counts, indicating that their excess bleeding risk may be because of factors other than platelet counts. This trial was registered at www.clinicaltrials.gov as #NCT00128713.

Original languageEnglish (US)
Pages (from-to)748-760
Number of pages13
JournalBlood
Volume120
Issue number4
DOIs
StatePublished - Jul 26 2012

Fingerprint

Platelet Transfusion
Platelets
Thrombocytopenia
Hemorrhage
Blood Platelets
Pediatrics
Therapeutics
Platelet Count
Age Groups
Autografts
Hemostatics
Health

ASJC Scopus subject areas

  • Hematology
  • Biochemistry
  • Cell Biology
  • Immunology

Cite this

Josephson, C. D., Granger, S., Assmann, S. F., Castillejo, M. I., Strauss, R. G., Slichter, S. J., ... Sloan, S. R. (2012). Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia. Blood, 120(4), 748-760. https://doi.org/10.1182/blood-2011-11-389569

Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia. / Josephson, Cassandra D.; Granger, Suzanne; Assmann, Susan F.; Castillejo, Marta Inés; Strauss, Ronald G.; Slichter, Sherrill J.; Steiner, Marie E.; Journeycake, Janna M.; Thornburg, Courtney D.; Bussel, James; Grabowski, Eric F.; Neufeld, Ellis J.; Savage, William; Sloan, Steven R.

In: Blood, Vol. 120, No. 4, 26.07.2012, p. 748-760.

Research output: Contribution to journalArticle

Josephson, CD, Granger, S, Assmann, SF, Castillejo, MI, Strauss, RG, Slichter, SJ, Steiner, ME, Journeycake, JM, Thornburg, CD, Bussel, J, Grabowski, EF, Neufeld, EJ, Savage, W & Sloan, SR 2012, 'Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia', Blood, vol. 120, no. 4, pp. 748-760. https://doi.org/10.1182/blood-2011-11-389569
Josephson, Cassandra D. ; Granger, Suzanne ; Assmann, Susan F. ; Castillejo, Marta Inés ; Strauss, Ronald G. ; Slichter, Sherrill J. ; Steiner, Marie E. ; Journeycake, Janna M. ; Thornburg, Courtney D. ; Bussel, James ; Grabowski, Eric F. ; Neufeld, Ellis J. ; Savage, William ; Sloan, Steven R. / Bleeding risks are higher in children versus adults given prophylactic platelet transfusions for treatment-induced hypoproliferative thrombocytopenia. In: Blood. 2012 ; Vol. 120, No. 4. pp. 748-760.
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abstract = "Age-group analyses were conducted of patients in the prophylactic platelet dose trial (PLADO), which evaluated the relation between platelet dose per transfusion and bleeding. Hospitalized patients with treatment-induced hypoproliferative thrombocytopenia were randomly assigned to 1 of 3 platelet doses: 1.1 × 10 11, 2.2 × 10 11, or 4.4 × 10 11 platelets/m 2 per transfusion, given for morning counts of ≤ 10 000 platelets/μL. Daily hemostatic assessments were performed. The primary end point (percentage of patients who developed grade 2 or higher World Health Organization bleeding) was evaluated in 198 children (0-18 years) and 1044 adults. Although platelet dose did not predict bleeding for any age group, children overall had a significantly higher risk of grade 2 or higher bleeding than adults (86{\%}, 88{\%}, 77{\%} vs 67{\%} of patients aged 0-5 years, 6-12 years, 13-18 years, vs adults, respectively) and more days with grade 2 or higher bleeding (median, 3 days in each pediatric group vs 1 day in adults; P < .001). The effect of age on bleeding differed by disease treatment category and was most pronounced among autologous transplant recipients. Pediatric subjects were at higher risk of bleeding over a wide range of platelet counts, indicating that their excess bleeding risk may be because of factors other than platelet counts. This trial was registered at www.clinicaltrials.gov as #NCT00128713.",
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AU - Castillejo, Marta Inés

AU - Strauss, Ronald G.

AU - Slichter, Sherrill J.

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