Scripties UMCG - Rijksuniversiteit Groningen
 
English | Nederlands

Profylactische trombocytentransfusies bij patiënten met een hemato-oncologische ziekte: werken naar efficiëntere inzet en betere kwaliteit van leven

(2019) Burg, M.C. van der

Background
Patients with a haemato-oncological disease tend to have low platelets as result of the disease and intensive chemotherapy. A higher bleeding risk occurs and serious complications, such as brain haemorrhage, can follow. To reduce this risk, prophylactic platelet transfusions are administered. This study aimed to investigate the influence of treatment and disease on platelet function as a predictor of bleeding. Furthermore, we examined the impact of platelet transfusions on quality of life.
Methods Prospective cohort study in Meander MC and UMCU on bleeding risk and platelet function in thrombopenic haemato-oncological patients and quality of life. Platelet function was studied during remission-induction therapy and consolidation therapy and between patients with leukaemia and patients with lymphoma. The bleeding risk between these diseases was investigated as well.
Bleeding was categorized according to the WHO bleeding scale. Platelet reactivity, shown as P-selectin expression, to stimulation by four agonists (ADP, CRP-xL, PAR1-AP en PAR4-AP) was measured using flow cytometry.
Quality of life was assessed using the EQ-5D-5L questionnaire, which estimates the scores for utility and EQ-visual analog scale. Patients were asked to fill in the questionnaire before- and after platelet transfusion.
Results To study platelet function and bleeding risk, 43 patients were included. The expression of P-selectin is lower during remission-induction therapy compared to consolidation therapy after CRP-xL and PAR4-AP stimulation with a mean difference of respectively -0.28 (95% CI -0.47 - -0.09; s) and -0.20 (95% CI -0.32 - -0.07; s). After correction for kind of treatment, the expression of P-selectin is higher in patients with leukaemia compared to patients with lymphoma after stimulation with PAR1-AP with a mean difference of 0.19 (95% CI 0.02 – 0.36; s). The odds ratio is 2.7 (95% CI 0.7 – 10.7; ns) for bleeding risk between these diseases.
To study the impact of platelet transfusions on quality of life, data of 18 patients was used to measure utility. To measure VAS we used data of 20 patients. The mean difference of utility after- compared to before platelet transfusion is 0.0 (SD 0.1; ns). The mean difference of VAS is 1.5 (SD 14.2; ns).
Conclusion
Platelet function seems worse during remission-induction therapy compared to consolidation therapy after stimulation with CRP-xL and PAR4-AP. Also, after correction for the kind of treatment, platelet function seems relatively better in patients with leukaemia compared to patients with lymphoma after stimulation with PAR1-AP. There is no significant difference in bleeding risk between these diseases. Furthermore, platelet transfusions have no significant impact on quality of life for patients with a haemato-oncological disease.






 
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