Platelet transfusion in patients undergoing minor invasive procedures: Balancing risks and benefits

This thesis focused on the balance of platelet transfusion benefits and risks in patients with a low platelet count (thrombocytopenia), undergoing minor invasive procedures. Thrombocytopenic patients have an increased risk of bleeding after minor procedures, such as central venous catheter placement. Even though the association between thrombocytopenia and bleeding risk is evident, the efficacy of prophylactic platelet transfusion to prevent bleeding after minor invasive procedures is uncertain. However, transfusion exposes patients to potential harm. To gain insight in the occurrence of bleeding, a systematic review of the literature was performed. We found severe bleeding after central venous catheter placement to be rare, even in severely thrombocytopenic patients. In a questionnaire amongst Dutch physicians, we found the current transfusion practice is highly variable. To assess the efficacy of prophylactic platelet transfusion prior to central venous catheter placement in severely thrombocytopenic patients, the PACER trial was initiated. Inclusion of patients in this first prospective randomized controlled trial is ongoing. To assess the effect of donor characteristics on transfusion outcomes, two cohorts of patients with transfusion related acute lung injury (TRALI) were analyzed. Donor characteristics were not associated with an increased risk of TRALI. We demonstrated biotin can be used as non-radioactive label to trace transfused platelets for research purposes in vivo. Labeling of platelets is required to distinguish transfused platelets from the recipient’s own circulating platelets. Biotinylation of platelets offers a novel method with many possibilities for future research.