The effect of prophylactic platelet transfusions on point-of-care coagulation parameters in conjunction to central venous catheter insertion—what effect do transfusions have and are they necessary?

Sammanfattning: Introduction: Platelet transfusions are often used when thrombocytopenic patients are facing a central venous catheter (CVC) insertion, but their use has been up to debate. Point-of-care devices such as thromboelastometry (ROTEM) and platelet aggregometry (Multiplate) better reflect in vivo haemostasis than routine coagulation tests. Aim of the study was to investigate the effects of platelet transfusions administered before CVC insertion, using ROTEM and Multiplate. Materials and methods: Informed and signed consent was attained from all patients. Patients with a platelet count < 50 ∙ 109/L received platelet transfusion before CVC insertion (transfusion group, n=14). The patients' blood was analysed with routine coagulation and point-of-care tests (ROTEM, Multiplate) before as well as one and four hours after transfusion. A reference group with non- thrombocytopenic patients (≥ 50 ∙ 109/L) scheduled for CVC insertion was also analysed (n=32). Clinical data for patients as well as the age of the platelet units and the number of units used were recorded. Results: The ROTEM clot firmness parameter, Extem MCF increased after platelet transfusion, with a sustained response after four hours. The increments in Extem MCF were significantly higher in women and when using two platelet units. The increments in Multiplate parameters after transfusion did not reach significance. The Multiplate adenosine diphosphate-agonised assay indicated severe platelet dysfunction before and after transfusion, and the values were significantly lower in women . Conclusion: In patients with haematological malignancies and thrombocytopenia, ROTEM can be used to monitor the effect of a prophylactic platelet transfusion. Platelet transfusion strategies involving ROTEM and Multiplate should be tested in a larger study. The clinical significance of very low Multiplate values before and after platelet transfusions in severely thrombocytopenic patients needs to be verified with flow cytometry.