1. Platelet transfusion: Experience of the gastro-enterology departement Charles Nicolle Hospital BEN SAID M, SAID Y, BAHLOUL A, NAJJAR T, GUERMAZI S

2. Introduction:  Platelet transfusion: complex act needing the consideration of several factors.  Platelet transfusion in patients with acute or chronic liver disease:  Curative: active bleeding  Preventive: biopsy, embolization….   Objective: we report in this work our experience with platelet transfusion in this particular situation.

3. Patients & Methods:  Retrospective study: October 2007 → February 2012.  A fact sheet was designed to collect: Indication Epidemiological data Clinical and hematological data Transfusion

4.  16 patients: Mean ageSex-ratio M/FNumber of transfusion episodes 53 years [15-73]1,620 Acute hepatitis N = 2 Cirrhosis N= 14

5. RESULTS

6. Curative platelets transfusion:  Causes: 7 patients (45%) Severe thrombocytopenia < 10G/L (n=2) Thrombocytopenia with hemorrhagic events (n=5) Central:Peripheral: -Bone marrow aplasia -Bone marrow metastases -Disseminated intravascular coagulation -Hypersplenism

7.  Efficiency criteria:  Increase of Plt-count > 20 %  Stop of bleeding A clinical response associated with an efficient transfusion Failure: 2/7 patients 5/7 patients Causes: s: -The severity of thrombocytopenia. - An important hypersplenism.

8. Preventive platelets transfusion:  9 patients (55%): Cirrhosis with hypersplenism:  Indications: Before: Viral etiology (n = 7)Others (n = 2) - Liver biopsy - Chemo embolization (adeno K) - Polypectomy… Associated with thrombocytopenia ( 70 years). Prothrombin time was <50% in 88% of cases

9.  Efficiency of transfusion: 82 % of cases: 82 % of cases: → the different acts were held without incidents. → the different acts were held without incidents. 18 % of cases: 18 % of cases:  Hypersplenism  Insufficient amount of SPC Increase of Plt Count > 20 % (+) no bleeding: Failure:

10. Comments (1)  Thrombocytopenia in patients with hepatopathies are related to: - hypersplenism - hypersplenism -viral etiology of cirrhosis or hepatitis -viral etiology of cirrhosis or hepatitis -central origin -central origin  Risk of bleeding is majorated by low prothrombin time

11. Comments (2):  Efficiency of platelet transfusion is limited by hypersplenism  The failure of curative transfusion of platelets is observed in patients with severe thrombopenia, DIC  The minimal platelet count needed in prophylatic transfusion is no well established.

12. Conclusion:  Curative and preventive transfusion of platelets are not well codified in patients with hepatopathies.  Prospective studies are needed to establish guidelines.