Platelet transfusions administered to patients with splenomegaly

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Abstract
It is generally felt that increments in platelet counts following platelet transfusions to patients with splenomegaly are severely reduced as a result of splenic sequestration. The results of 631 random-donor platelet transfusions administered to 66 thrombocytopenic patients with palpable splenomegaly were analyzed. Increasing splenomegaly had a significant effect on corrected count increments (CCls), with the greatest deterioration occurring in patients whose spleens were palpable > 2.0 cm below the left costal margin. A similar trend was noted when the percentage of transfusions with satisfactory CCls was compared, although it should be noted that 42 percent of the transfusions produced CCls > 7500, and a large proportion produced clinically helpful absolute increments. Splenomegaly also had an effect on platelet survival: in patients with CCls > 7500, the mean ratio of 24-hour CCls to 1-hour CCls was 0.29 to 0.47 in patients with various degrees of splenomegaly, as compared to an expected value of 0.6 to 0.7. Sixteen patients, most with spleens palpable < 5.0 cm below the left costal margin, consistently had CCls > 7500. A significant fraction of patients with splenomegaly can benefit from platelet transfusion, and thus splenomegaly should not preclude intensive therapeutic approaches.