Background: Thrombocytopenia is common among head injury patients. However there is a paucity of literature on the effects of platelet transfusion and clinical outcome in this group. We conducted this study to compare the severity of injury, transfusion requirements, in hospital mortality in thrombocytopenic and non thrombocytopenic head injury patients, also to study the response to platelet transfusion.
Materials & Methods: Retrospective cohort analysis of clinical, laboratory and blood bank parameters of head injury patients was performed over a six month period (Jan-June 2011). Thrombocytopenia was defined as platelet count < 100×109cells/L. Severity of head injury, hospital length of stay, transfusion requirements, presence of coagulopathy and hospital mortality were assessed. A ≥20% increase in platelet count from baseline, 24 hours post transfusion was considered appropriate response. H/o drug (cefaperazone and mannitol) intake, fever, symptomatic bleeding, and transfusion history (days of storage and blood group of transfused platelet, H/o other blood components transfused, and transfusion reaction) were compared.
Results: A total of 139 thrombocytopenic patients and 87 non-thrombocytopenic patients were assessed. Severity of injury was significantly higher in thrombocytopenic group (GCS 8.7±4.2; ISS 24.5 (0-75) as compared to the non thrombocytopenic group (GCS 12.3±4.1; ISS 6.7 (0-25); (p<0.001) 62.6% thrombocytopenic patients developed coagulopathy (p<0.04). Thrombocytopenia was a risk factor for mortality (p<0.001). Patients who received ABO matched platelets showed appropriate response. Coagulopathy, h/o of drugs, fever, and days of storage for platelet units had no correlation with transfusion response.
Conclusion: Thrombocytopenic head injured patients have significantly higher severity of injury, increased ICU stay, incidence of coagulopathy and poorer prognosis. However a significant relation of clinical, patient and blood bank related factors with post transfusion platelet increment was not observed. Prospective studies are needed to determine predictors of ineffective platelet transfusion response in head injured patients. |
