Schiffer, C.A., Bohlke, K., Delaney, M., Hume, H., Magdalinski, A.J., McCullough, J.J., . . . Anderson, K.C. (2018). Platelet transfusion for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology, 36, 283–299.

PURPOSE: To provide evidence-based guidance on the use of platelet transfusion in patients with cancer.

TYPES OF PATIENTS ADDRESSED: Adults and children (> 4 months of age)

RESOURCE TYPE: Evidence-based guideline

PROCESS OF DEVELOPMENT: Expert panel conducted an SR from 2014-2016. The current guideline builds on previous ASCO guidelines first published in 2001. For new questions not addressed by previous guidelines, the search went back to 2000.

DATABASES USED: PubMed and Cochrane     
    

INCLUSION CRITERIA: Adults and children (> 4 months) with cancer, prophylactic or therapeutic platelet transfusion; outcomes were bleeding, alloimmunization, and platelet refractoriness. Publication types were CPG, SR, MA, RCT, and observational studies.
  

 EXCLUSION CRITERIA: Meeting abstracts not published in peer-reviewed journals, editorials, etc. Non-English publications

PHASE OF CARE: Multiple phases of care

APPLICATIONS: Pediatrics, elder care, palliative care

24 total publications were new to this guideline: 3 CPG, 8 SRs, and 13 observational studies.

The most significant change involved platelet transfusion in HSCT. Adult patients who undergo autologous stem cell transplantation at experienced centers may receive a transfusion at the first sign of bleeding. Prophylactic platelet transfusion at defined thresholds is still recommended for pediatric patients undergoing autologous SCT and for adults and pediatric patients undergoing allogeneic SCT.

Relatively few studies are available on prophylactic platelet transfusions in solid tumors, and information is lacking about the safety of invasive procedures in patients with thrombocytopenia.

This is an updated guideline for adult and pediatric patients who require platelet transfusions.