Improving platelet transfusion practice: examining the quality of guidelines

We need platelets to perform vital functions in our bodies: they help heal our wounds and prevent us from bleeding excessively. We also need a certain number of them—what’s referred to as our platelet blood count—for these functions to be carried out effectively. Faced with an increased risk of bleeding, people with a low platelet blood count, such as cancer patients receiving chemotherapy, can boost their numbers with a platelet transfusion. But how low does a person’s platelet count have to be before they would benefit from a platelet transfusion?

To help answer questions like this, doctors turn to evidence-based guidelines. According to Dr. Arwa Al-Riyami, a senior consultant hematopathologist at Sultan Qaboos University Hospital in Oman, assessing the quality of guidelines and inconsistencies among guidelines is an important, but often overlooked consideration. “Platelets should be used for the right reasons, and in the right way,” says Dr. Al-Riyami. “Although guidelines intend to increase consistency in clinical practice and the quality of patient care, if there are variations in methodology and recommendations among different guidelines, this could influence how useful they are in guiding practice.”

To evaluate the quality of existing platelet transfusion guidelines, Dr. Al-Riyami and her colleagues in The International Collaboration for Transfusion Medicine Guidelines (ICTMG), recently published a paper in the journal Transfusion. The paper was selected by the NHS Blood and Transplant Systematic Review Initiative as one of the top 10 publications in March. ICTMG is a global network of experts—hematologists, physicians, and methodologists—supported by Canadian Blood Services.

Dr. Al-Riyami shared some key takeaways from the ICTMG review.

Why did ICTMG do a systematic review on platelet transfusion guidelines?

Platelets are commonly administered, but we didn’t know the quality of the existing guidelines for platelet transfusions. We also wanted to describe any inconsistencies in recommendations that exist in these guidelines.

Where did you find inconsistencies?

We reviewed seven guidelines and found inconsistencies in these areas:

• When should a platelet transfusion be given? For patients who are unable to produce platelets on their own, and who have other factors that increase their risk for bleeding, we found inconsistent recommendations on how low their platelet count would have to be before a doctor orders a platelet transfusion.

• How much should a doctor transfuse to a patient? The recommended dose of platelets was not consistent among guidelines.

• How should the guidelines be applied? The guidelines got low marks for addressing the practical aspects of implementation. For example, what tools facilitate implementation of the guideline in clinical practice, what barriers prevent implementation, and how can we monitor if the guideline recommendations are being applied?

• What do the guidelines say about kids and babies? We found only one guideline that discussed platelet transfusion in kids and babies, which is an important patient group to consider.

• Were patients involved in developing recommendations? Only one guideline involved patients in the guideline development process. Patients are increasingly involved in all areas of health-care policy development and more efforts should be made to ensure their views are captured.

How will the new ICTMG systematic review improve patient care?

The review highlights what areas are important to address when developing future platelet transfusion guidelines. Certainly, it has informed the work of ICTMG as it is currently working on updating its platelet transfusion guideline published in 2015.

ICTMG has members from a number of different countries and so its guidelines are adaptable to different settings. Ultimately, high-quality guidelines can improve patient care, no matter what country they live in.

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Visit the ICTMG website to find their recent systematic review on quality of evidence-based guidelines for platelet transfusion and use, along with other resources for transfusion practice.

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The opinions reflected in this post are those of the author and do not necessarily reflect the opinions of Canadian Blood Services nor do they reflect the views of Health Canada or any other funding agency.