November 1st 2002
Drs. Goodnough and DiPersio present an authoritative and informative discussion of the management of thrombocytopenia in the cancer patient, emphasizing the risks of platelet transfusions, the safety of a platelet count threshold of < 10,000/µL for prophylactic transfusions, and issues related to the optimal type of platelet product and dose of platelets. The authors make the important point that although the risk of transmission of viral infections has decreased markedly due to the addition of nucleic acid testing for hepatitis C and human immunodeficiency virus (HIV), sepsis due to bacterial contamination remains a serious risk, particularly for the neutropenic patient. The fever and chills that occur within 6 hours after a platelet transfusion usually are associated with nonhemolytic febrile transfusion reactions, but the more dangerous possibility of bacterial sepsis from contamination should be considered, particularly in the neutropenic patient, and treated empirically until bacterial cultures prove otherwise.