Platelet transfusions administered to patients with splenomegaly

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 (CCIs), with the greatest deterioration occurring in patients whose spleens were palpable greater than 2.0 cm below the left costal margin. A similar trend was noted when the percentage of transfusions with satisfactory CCIs was compared, although it should be noted that 42 percent of the transfusions produced CCIs greater than 7500, and a large proportion produced clinically helpful absolute increments. Splenomegaly also had an effect on platelet survival: in patients with CCIs greater than 7500, the mean ratio of 24-hour CCIs to 1-hour CCIs 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 less than 5.0 cm below the left costal margin, consistently had CCIs greater than 7500. A significant fraction of patients with splenomegaly can benefit from platelet transfusion, and thus splenomegaly should not preclude intensive therapeutic approaches.