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October 25, 1985

Hematology and Oncology

JAMA. 1985;254(16):2259-2262. doi:10.1001/jama.1985.03360160091018

Appropriate management of patients with hematologic and oncological disorders continues to be controversial. Two topics to be discussed in this year's CONTEMPO are the efficacy of platelet transfusions for patients rendered thrombocytopenic by chemotherapy and the appropriateness of chemotherapy for myelodysplastic anemia. Although no new advances have occurred in the diagnosis of iron deficiency anemia, this problem takes on particular significance in evaluating volunteer blood donors.

Intensive chemotherapy for malignancies has resulted in dramatic increases in platelet transfusions,1 and these are credited with reducing deaths from hemorrhage in thrombocytopenic patients. Critical questions have been raised, however, about the choice of platelet product to administer. Among patients treated with platelets from random donors harvested from individual whole-blood donations, approximately one third of those who survive the chemotherapy induction phase become alloimmunized.

To delay the emergence of alloimmunization, some clinicians have advocated use of a more restricted number of HLA-unmatched donors