Hi Freedom,
My platelet count was not as severe as what you noted regarding your wife. My counts went below 10 only following two different Dacogen cycles. Most of the time I was in the 20's. Having been previously diagnosed with ITP my hemo was able to put me on Nplate. As I understand it neither Nplate nor Promacta have been approved for MDS, although trials are underway. Nplate got my count up to about 40 (again I'm talking thousands here), but that was with a very cautious approach in dosing - never went above half the peak stepped dose level. Next my hemo put me on thalidomide, along with prednisone, since it had been shown it not only increased the platelet count in many on the drug, but also reduced the size of the spleen in some. OK that enabled my count to remain in the 40's, but did not shrink or even keep my spleen from enlarging. Therefore my spleen was removed last month and my count promptly went into the normal range - 245,000 as of 6/6/11. So that's where I'm at now. By the way, my hemo gave me a prescription that was only to be used if I encountered uncontrolled bleeding. While it was never required, it provided some comfort knowing if was on hand.
Exjade would be inappropriate to say the least for your wife since the manufacturer notes it is contraindicated for those having a platelet count of less than 50,000.
In spite of having read quite a bit about platelet transfusions, the complexity is still daunting. Nonetheless, I'll offer a few bits of info that I hope are on track. A person who gets a platelet transfusion gets a bag of either pooled or apheresis platelets. Pooled are the most common. This is where they remove the platelets from five, or so, different whole blood donor bags. An apheresis bag of platelets is from a single donor. So the chance of getting an infection from the donated bag is five times greater in the former rather than the latter - it's still a very small chance. Now to answer your question about filtered platelets - I believe all platelets collected are filtered for leukocytes (leukoreduction). The next step up, increasing the cost, is cross matched platelets. I think this is where a small sample of your blood is mixed with some platelets from a donor bag.
Now the next step gets much more costly and that's the use of HLA (human leukocyte antigen) platelets. I was scheduled for a splenectomy last October when my count was only 26,000 and my doctor had asked for HLA matched platelets to be on hand at the hospital. The hospital refused as it was too costly and they were afraid of being stuck with the HLA costs in case of a cancellation. In fact my hemo did cancel the surgery which I subsequently had last month when my count was 46,000.
Here are a couple of associated references:
http://en.wikipedia.org/wiki/Plateletpheresis
http://pathcuric1.swmed.edu/Resident...FSCOMHLAP.HTML
Bill F