Saleem Ahmad Siddiqui, M Mofazzel Hossain, Muhammad Ayub.
Platelet transfusion in acute myeloid leukemia.
Pak J Pathol Jan ;10(2):11-5.

Treatment of acute myeloid leukaemia with drugs is associated with marked myelosuppression resulting in severe thrombocytopenia which may or may not be accompanied by clinically evident bleeding episodes. Platelet counts in few patients may drop to as low as 500 per cubic millimeter (/cmm) . Without evidence of bleeding manifestations or fatality. This observation led us to propose platelet therapy in AML on `No Bleeding No Platelet Transfusion` basis rather than at a fixed threshold - consensus of which is yet to be reached. This study involved observation of thrombocytopenia in 30 de novo AML patients during 82 courses of myelosuppressive chemotherapy. Induction chemotherapy was given by standard regimen and subsequent 52 courses of intensification by high dose Ara-c (HIDAC). The platelet threshold for prophylactic transfusion was kept at , 10000/cmm unless other clinical conditions warranted transfusion at higher levels. The platelet counts were performed by Sysmex 1000 automated blood cell counter on alternate days. In some case platelet counts dropped to <5000/cmm or even to 500/cmm without evidence of overt bleeding. Out of 82 courses of myelosuppression, 21 courses (25.60%) were associated with thrombocytopenia > 10000/cmm with 6(28.57%) clinical evidence of bleedings, 15 (71.42%) without bleeding. During sixty one courses (74.39%) platelet counts droped <1000/cmm, of which 19 (31.14%) had bleeding manifestation and 42(68.85%) had no bleeding. Of importance and interest is platelet count <500/cmm in 11 (26.82%) of courses, only 2 (18.18%) of which had clinical evidence of bleeding, 9 (81.81%) had no bleeding despite very low platelet. Platelet requirements were 11.33 units/ patient on average in groups with counts > 100001cmm, 9.96 units/patient on average in groups with count <10000/cmm whereas 10.14 units/patient on average in groups <5000/cmm.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com