医学
重症监护医学
血小板输注
止血
危害
血小板
临床试验
疾病
输血医学
随机对照试验
血液管理
免疫学
输血
外科
内科学
政治学
法学
作者
Cheryl L. Maier,Simon Stanworth,Martha Sola-Visner,Daryl J. Kor,Alan E. Mast,Ross M. Fasano,Cassandra D. Josephson,Darrell J. Triulzi,Marianne Nellis
标识
DOI:10.1016/j.tmrv.2023.150751
摘要
The optimal use of prophylactic platelet transfusion remains uncertain in a number of clinical scenarios. Platelet count thresholds have been established in patients with hematologic malignancies, yet thresholds backed by scientific data are limited or do not exist for many patient populations. Clinical scenarios involving transfusion thresholds for thrombocytopenic patients with critical illness, need for surgery or invasive procedures, or those involving specials populations like children and neonates, lack clear evidence for discerning favorable outcomes without undue risk related to platelet transfusion. In addition, while prophylactic platelet transfusions are administered with the goal of enhancing hemostasis, increasing evidence supports critical non-hemostatic roles for platelets related to innate and adaptive immunity, inflammation, and angiogenesis, which may impact patient responses and outcomes. Here we review several recent studies conducted in adult or pediatric patients that highlight the limitations in our current understanding of prophylactic platelet transfusion. Together, these studies underscore the need for additional research, especially in the form of robust randomized clinical trials and integrating additional parameters beyond the platelet count. Future research at the basic, translational and clinical levels will best define the optimal role for prophylactic transfusion across the lifespan and its broader impact on health and disease.
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