People with myelodysplastic syndromes (MDS) may often receive platelet transfusions for thrombocytopenia, despite indicators that bleeding may occur at a wide range of platelet counts and the lack of evidence for their efficacy, according to an article published in the European Journal of Haematology.
In this retrospective cohort study, the researchers analyzed the hospital medical records of 170 adult patients with MDS, chronic myelomonocytic leukemia, or MDS/myeloproliferative overlap neoplasm, admitted from 2016 to 2018 to their clinic in Australia.
According to the results, the median platelet count at first admission was 90 × 109/L while 28 patients (15.6%) had a platelet count of less than 20 × 109/L, which can be considered severe thrombocytopenia. Of those patients, 9 (32.1%) were given prophylactic platelet transfusions, 5 (17.9%) were treated with tranexamic acid, 7 (25%) with both platelet transfusions and TXA, while 7 (25%) patients remained treatment free.
Twenty patients (11.2%) experienced bleeding events requiring hospitalization and 3 patients with varying platelet counts (18, 38 and 153 × 109/L) died as a result of bleeding. Evidence suggests that the occurrence of bleeding could not be predicted by presenting platelet count, tranexamic acid use, platelet transfusion, or anticoagulant/antiplatelet therapies.
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“Our study highlights the need for clinical trials to determine the predictors of bleeding, and the efficacy and safety of platelet transfusions, tranexamic acid or other therapeutic agents, in MDS patients. Future trials should focus on outcomes important to patients, such as clinically significant bleeding and quality of life, not just laboratory results such as platelet counts. They should also incorporate health economics outcomes, given the costs and other resources required for administering regular platelet transfusions, and the potential burden for patients, including frequent hospital admission,” Mo and colleagues emphasized.
As many as 40% to 65% of patients with MDS suffer thrombocytopenia, while the incidence of bleeding complications ranges from 3% to 53%. Although there is limited clinical evidence to support the prophylactic use of platelet transfusions in MDS, they are often used in this patient population.
Mo A, Wood E, Shortt J, Hu E, McQuilten Z. Platelet transfusions and predictors of bleeding in patients with myelodysplastic syndromes. Eur J Haematol. Published online July 15, 2023. doi:10.1111/ejh.14049