St. Jude Researchers Determine Expensive Preventive Treatment Is Not Necessary

St. Jude Children's Research Hospital (ALSAC)
Tuesday, 31 October 2000

Study Finds Patients Are Not at Higher Risk

(Memphis, Tennessee, October 31, 2000) Pediatric patients diagnosed with Acute Lymphoblastic Leukemia (ALL) who have low platelet counts and require an important diagnostic test or treatment procedure do not need a platelet transfusion according to researchers at St. Jude Children's Research Hospitalâ. In the November 1 issue of the Journal of the American Medical Association (JAMA), St. Jude principal investigators Scott Howard, M.D., and Ching-Hon Pui, M.D., dispute what has always been considered a medically necessary step before lumbar puncture (LP).

Lumbar punctures are routinely performed to determine the level of disease in the spinal fluid. The procedure is also performed to administer medications in the spinal canal to prevent or treat leukemia in the central nervous system. Traditionally, platelet transfusion is considered medically necessary to prevent bleeding problems, while performing the LP to a patient with low platelet count. This approach generally has been adopted by clinicians and supported by medical textbooks.

Platelets act as the body's "internal bandage," by helping the blood to clot. Scott Howard, M.D., the paper's principle author states, "It is gratifying to discover that children with leukemia can be spared unnecessary platelet transfusion before their procedure, which eliminates the small risk of an adverse reaction and conserves platelets for other children who truly need them."

The St. Jude study covers 14 years (1984-1998) and includes over 5,000 LPs. It shows no serious complications associated with the lack of transfusion. Such complications could include neurologic, infectious or bleeding problems.

This study is important because blood resources are often scarce and the cost of blood products can be prohibitive. The national average cost for a unit of pheresed platelets, or platelets separated from donors' blood with the rest of the components returned to them, without any special consideration such as HLA typing or screening for specific components, ranges from $500 to $700. A patient aged 10 years or younger generally receives one-half unit, whereas a patient over 10-years-old would generally receive a full unit.

Additionally, transfusion can result in serious, but rarely fatal, complications. The patient may contract an infection because the blood product can contain a virus or bacteria. Other complications include breaking down red blood cells due to blood type incompatibility and allergic reactions.

"Investigators at St. Jude have always challenged the conventional wisdom and have done so for more than 35 years," states Ching-Hon Pui, M.D., one of the paper's authors. "We have now proved that it is unnecessary to perform prophylactic platelet transfusions for children undergoing treatment for acute lymphoblastic leukemia. It is important that we share this information with our colleagues."

St. Jude Children's Research Hospital, in Memphis, Tennessee, was founded by the late entertainer Danny Thomas. The hospital is an internationally recognized biomedical research center dedicated to finding cures for catastrophic diseases of childhood. The hospital's work is supported through funds raised by the American Lebanese Syrian Associated Charities (ALSAC). All St. Jude patients are treated regardless of their family's ability to pay. ALSAC covers all costs of treatment beyond those reimbursed by third party insurers, and total costs for families who have no insurance.

For more information, or to contact St. Jude Children's Research Hospital (ALSAC), see their website at: www.stjude.org