Platelet transfusions and predictors of bleeding in patients with myelodysplastic syndromes | Aplastic Anemia and MDS International Foundation (AAMDSIF) Return to top.

Platelet transfusions and predictors of bleeding in patients with myelodysplastic syndromes

Journal Title: 
European Journal of Haematology
Primary Author: 
Mo A
Mo A, Wood E, Shortt J, Hu E, McQuilten Z
Original Publication Date: 
Saturday, July 15, 2023
Bone Marrow Disease(s): 

Objectives: This study aimed to describe the burden of thrombocytopenia, supportive care practices, bleeding complications and predictors of bleeding in MDS patients within a large Australian hospital network, to better understand the use and effectiveness of platelet transfusions in MDS.

Methods: A retrospective cohort study of patients aged ≥18 years with MDS, chronic myelomonocytic leukaemia or MDS/myeloproliferative overlap neoplasm admitted from 2016 to 2018 was conducted. Data were obtained from hospital medical records.

Results: One hundred seventy-nine patients (median age 78 years, 61.5% male) were identified. The median platelet count at first admission was 90 × 109 /L. Twenty-eight (15.6%) patients had severe thrombocytopenia (platelet count <20 × 109 /L), of whom nine (32.1%) received prophylactic platelet transfusions, five (17.9%) received tranexamic acid (TXA), seven (25%) received both platelet transfusions and TXA, and seven (25%) received no treatment. Bleeding events requiring hospitalisation occurred in 20 (11.2%) patients. Bleeding was not predicted by presenting platelet count, TXA use, platelet transfusion or anticoagulant/antiplatelet therapies. Three patients died of bleeding, at varying platelet counts (18, 38 and 153 × 109 /L).

Conclusion: Thrombocytopenia is common in MDS. Although guidelines recommend otherwise, prophylactic platelet transfusions were commonly used for severe thrombocytopenia. Despite the majority of patients receiving platelet transfusions and/or TXA, 11% developed major bleeding occurring at a wide range of platelet counts.

Keywords: haemorrhage; myelodysplastic syndromes; platelet transfusion; thrombocytopenia.