The results of the ‘Trial of prophylactic vs no prophylactic platelet transfusions’ known as the TOPPS trial have been published in the New England Journal of Medicine.
The research led by Dr Simon J. Stanworth, was funded by NHS Blood and Transplant and the Australian Red Cross Blood Service. Patients undergoing treatment (chemotherapy or stem cell transplants) for leukaemia, lymphoma, or myeloma often experience a large decrease in platelet counts. This leaves them at risk of severe bleeding. Current standard practice is to give these patients prophylactic platelet transfusions to protect against bleeding. There has been ongoing debate as to the value of prophylactic platelet transfusions. Approximately 60% of platelets are given to patients prophylactically, to prevent, rather than to stop bleeding. However, platelet transfusions are a limited and costly resource that are not risk free. Speaking about the outcome of the trial, Dr Stanworth, NHS Blood and Transplant Oxford, John Radcliffe Hospital, said: “Our results indicate that prophylactic platelet transfusions reduced rates of bleeding events in patients with haematologic cancers. “The results of our study support the need for the continued use of prophylaxis with platelet transfusion and show the benefit of such prophylaxis for reducing bleeding, as compared with no prophylaxis.” Prophylactic platelet transfusions reduced WHO grade 2-4 bleeding rates in patients with haematological malignancies by 7% overall.
