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The effect of prophylactic platelet transfusions on point-of-care coagulation parameters in conjunction to central venous catheter insertion—what effect do transfusions have and are they necessary?

Hahr Schoug, Johan LU (2012) LÄKM01 20121
MD Programme
Abstract
Introduction: Platelet transfusions are often used when thrombocytopenic patients are facing a central venous catheter (CVC) insertion, but their use has been up to debate. Point-of-care devices such as thromboelastometry (ROTEM) and platelet aggregometry (Multiplate) better reflect in vivo haemostasis than routine coagulation tests. Aim of the study was to investigate the effects of platelet transfusions administered before CVC insertion, using ROTEM and Multiplate.

Materials and methods: Informed and signed consent was attained from all patients. Patients with a platelet count < 50 ∙ 109/L received platelet transfusion before CVC insertion (transfusion group, n=14). The patients' blood was analysed with routine coagulation and... (More)
Introduction: Platelet transfusions are often used when thrombocytopenic patients are facing a central venous catheter (CVC) insertion, but their use has been up to debate. Point-of-care devices such as thromboelastometry (ROTEM) and platelet aggregometry (Multiplate) better reflect in vivo haemostasis than routine coagulation tests. Aim of the study was to investigate the effects of platelet transfusions administered before CVC insertion, using ROTEM and Multiplate.

Materials and methods: Informed and signed consent was attained from all patients. Patients with a platelet count < 50 ∙ 109/L received platelet transfusion before CVC insertion (transfusion group, n=14). The patients' blood was analysed with routine coagulation and point-of-care tests (ROTEM, Multiplate) before as well as one and four hours after transfusion. A reference group with non- thrombocytopenic patients (≥ 50 ∙ 109/L) scheduled for CVC insertion was also analysed (n=32). Clinical data for patients as well as the age of the platelet units and the number of units used were recorded.

Results: The ROTEM clot firmness parameter, Extem MCF increased after platelet transfusion, with a sustained response after four hours. The increments in Extem MCF were significantly higher in women and when using two platelet units. The increments in Multiplate parameters after transfusion did not reach significance. The Multiplate adenosine diphosphate-agonised assay indicated severe platelet dysfunction before and after transfusion, and the values were significantly lower in women
.
Conclusion: In patients with haematological malignancies and thrombocytopenia, ROTEM can be used to monitor the effect of a prophylactic platelet transfusion. Platelet transfusion strategies involving ROTEM and Multiplate should be tested in a larger study. The clinical significance of very low Multiplate values before and after platelet transfusions in severely thrombocytopenic patients needs to be verified with flow cytometry. (Less)
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author
Hahr Schoug, Johan LU
supervisor
organization
alternative title
Profylaktiska trombocyttransfusioners effekt på konventionella och patientnära koagulationsparametrar vid inläggning av central venkateter – vad har trombocyttransfusioner för effekt och behövs de?
course
LÄKM01 20121
year
type
H2 - Master's Degree (Two Years)
subject
keywords
Platelet, Platelet transfusion, Thromboelastography, Thromboelastometry, Platelet aggregometry, ROTEM, Multiplate, Central venous catheter, CVC, Thrombocytopenia, Coagulation, Thrombocyte, Platelet function, Cancer, Hematological malignancy, Leukemia
language
English
id
2798158
date added to LUP
2012-08-24 11:07:25
date last changed
2012-08-24 11:07:25
@misc{2798158,
  abstract     = {Introduction: Platelet transfusions are often used when thrombocytopenic patients are facing a central venous catheter (CVC) insertion, but their use has been up to debate. Point-of-care devices such as thromboelastometry (ROTEM) and platelet aggregometry (Multiplate) better reflect in vivo haemostasis than routine coagulation tests. Aim of the study was to investigate the effects of platelet transfusions administered before CVC insertion, using ROTEM and Multiplate.

Materials and methods: Informed and signed consent was attained from all patients. Patients with a platelet count < 50 ∙ 109/L received platelet transfusion before CVC insertion (transfusion group, n=14). The patients' blood was analysed with routine coagulation and point-of-care tests (ROTEM, Multiplate) before as well as one and four hours after transfusion. A reference group with non- thrombocytopenic patients (≥ 50 ∙ 109/L) scheduled for CVC insertion was also analysed (n=32). Clinical data for patients as well as the age of the platelet units and the number of units used were recorded.

Results: The ROTEM clot firmness parameter, Extem MCF increased after platelet transfusion, with a sustained response after four hours. The increments in Extem MCF were significantly higher in women and when using two platelet units. The increments in Multiplate parameters after transfusion did not reach significance. The Multiplate adenosine diphosphate-agonised assay indicated severe platelet dysfunction before and after transfusion, and the values were significantly lower in women
.
Conclusion: In patients with haematological malignancies and thrombocytopenia, ROTEM can be used to monitor the effect of a prophylactic platelet transfusion. Platelet transfusion strategies involving ROTEM and Multiplate should be tested in a larger study. The clinical significance of very low Multiplate values before and after platelet transfusions in severely thrombocytopenic patients needs to be verified with flow cytometry.},
  author       = {Hahr Schoug, Johan},
  keyword      = {Platelet,Platelet transfusion,Thromboelastography,Thromboelastometry,Platelet aggregometry,ROTEM,Multiplate,Central venous catheter,CVC,Thrombocytopenia,Coagulation,Thrombocyte,Platelet function,Cancer,Hematological malignancy,Leukemia},
  language     = {eng},
  note         = {Student Paper},
  title        = {The effect of prophylactic platelet transfusions on point-of-care coagulation parameters in conjunction to central venous catheter insertion—what effect do transfusions have and are they necessary?},
  year         = {2012},
}