Wandt et al. have rightly pointed out that in many clinically stable patients with hematologic malignancies, the transfusion trigger can be set at <10 000/µL (1).
However, there is the exemption of promyelocytic leukemia. As the result of hyperfibrinolysis, the degradation of coagulation factors by proteolytic enzymes from the leukemia cells, and of cytokines, patients with this type of leukemia can develop disseminated intravascular coagulation (DIC) and ultimately a rapidly life-threatening coagulopathy (2).
According to German and international guidelines, platelet counts should be maintained at 30 000–50 000/µL in these patients (3, 4). Replacement treatment should be started very early, at times even before the diagnosis has been confirmed by molecular genetic testing (2).
References
- 1.Wandt H, Schäfer-Eckart K, Greinacher A. Platelet transfusion in hematology, oncology and surgery. Dtsch Arztebl Int. 2014;111:809–815. doi: 10.3238/arztebl.2014.0809. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Choudhry H, DeLoughery PG. Bleeding and thrombosis in acute proymyelocytic leukemia. Am J Hematol. 2012;87:596–603. doi: 10.1002/ajh.23158. [DOI] [PubMed] [Google Scholar]
- 3.Lengfelder E, Lambert J-F, Nachbaur D, et al. Akute Promyelozytäre Leukämie (APL) Leitlinie. Empfehlungen der Fachgesellschaft zur Diagnostik und Therapie hämatologischer und onkologischer Erkrankungen. www.dgho-onkopedia.de/de/onkopedia/leitlinien/akute-promyelozytaere-leukaemie. (last accessed on 16 March 2015) [Google Scholar]
- 4.Döhner H, Estey EH, Amadori S, et al. Recommendations from an international expert panel on behalf of the European LeukemiaNet. Blood. 2009;113:1875–1891. doi: 10.1182/blood-2008-04-150250. [DOI] [PubMed] [Google Scholar]