Hayat, Mohd Zamri Mohd
(2016)
Factors influencing platelet count increment after platelet transfusion among thrombocytopenic patients in Hospital USM.
Masters thesis, Universiti Sains Malaysia.
Abstract
Many studies had been performed to determine the factors that may contribute to posttransfusion
platelet increment. However, no documented data is available in our institution in
this area of knowledge yet. Therefore, this study was conducted to determine the transfusionrelated
factors that may influence post-transfusion platelet increment in thrombocytopenic
patients.
This retrospective cohort study involved 97 patients who received 351 of platelet transfusions
in Hospital Universiti Sains Malaysia within the period of January 2013 till December 2014.
The pre and post transfusion platelet counts were measured by using Sysmex haematology
analyzer XE5000 and the corrected count increment (CCI) was calculated at 1 hour and 24
hours post transfusion. Poor increment was defined as CCI<7500 m2/L at 1 hour and
CCI<4500 m2/L at 24 hours. The analyzed factors included, underlying malignancy, fever,
DIC, bleeding, splenomegaly, type of platelet concentrates (random versus apheresis), ABO
compatibility and age of platelet concentrates. Simple (SLR) and multiple logistic regression
(MLR) were used for statistical analysis and p-value of < 0.05 considered as significant.
Most patients were Malays (92.8%) with a median age of 47 years old. Male and female
patients were nearly equal in number. Majority of patients were O positive (40.2%) followed
by B positive (27.8%), A positive (26.8%) and AB positive (5.2%). The mean and median ofCCI was 15,834.54 m2/L and 10,350m2/L, respectively. The proportion patients with good
CCI was 66.1%.
SLR and MLR showed that only DIC, platelet age and ABO compatibility were significant
factors influencing post-transfusion platelet increment. DIC had 5.31 and 4.41 time adjusted
odds for poor post-transfusion platelet CCI (p-value<0.001, 95%CI=3.06,9.24) and platelet
refractoriness (p- value <0.001,95%CI=2.0,9.7), respectively. Meanwhile, platelet age of >3
days had 2.2 time adjusted odds of poor CCI compared to fresh platelet (p-value = 0.004, 95%
CI=1.29,3.75). ABO compatible platelet transfusion had 80% adjusted odds of unlikelihood
to get poor post-transfusion CCI compared with ABO identical platelet (p-value=0.011,
95%CI=0.06,0.65). Other clinical and laboratory factors were not statistically significant.
In conclusion, patients with DIC and who receive day ≥4 platelet concentrates will need more
platelet transfusions to achieve the desirable platelet increment compared to non DIC patients
and who receiving day ≤3 platelet concentrates patients, respectively. In addition, patients who
receive ABO compatible platelet concentrates may need fewer platelet transfusion than ABO
identical in achieving the similar target platelet level.
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