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Platelet Transfusion Guidelines:

Posted by sammy on February 5, 2013 at 4:30 PM

Platelets

Major Products Available:

 

Platelets concentrate (Random donor platelets -

RDP)

 

Platelets Pooled

 

Description/Contents:

 

RDP are separated from whole blood by differential

centrifugation. One unit of RDP contains at least

5.5x1010 platelets, typically 7.5x1010 platelets.

Pooled RDP are typically prepared from 4-6 units of

RDP. Platelets are suspended in donor plasma,

unless washed.

 

Indications:

 

Prevention/treatment of non-surgical bleeding

due to thrombocytopenia

UCG 2010

161

 

 

 

7. Guidelines for appropriate use of blood

If possible, prior to transfusion the reason for

thrombocytopenia should be established. When

thrombocytopenia is caused by marrow failure,

the following transfusion triggers are considered

appropriate: If platelet count is <10,000/µL

and no additional abnormalities exist. If

platelet count is between 10,000 and 20,000/µL

and coagulation abnormalities exist or there are

extensive petechiae or ecchymoses. If the

patient is bleeding at sites other than skin and

platelet count is <40-50,000/µ L.

 

Patients with accelerated platelet destruction

with significant bleeding (such as autoimmune

thrombocytopenia or drug-induced

thrombocytopenia).

The endpoint should be cessation of bleeding,

since an increment in platelet count is not likely

to be achieved. Prophylactic transfusion is not

indicated in these disorders.

Prior to surgical and major invasive procedures

when the platelet count is <50,000/ µL.

During neurosurgical and ophthamologic

procedures some authorities recommend that

the platelet count be maintained between

70,000 and 100,000/µL.

Bleeding with qualitative platelet defect

documented by history and/or laboratory tests.

The cause should be identified and corrected, if

possible, prior to surgery. Platelet transfusion is

indicated only if the defect cannot be otherwise

corrected: for example, a congenital platelet

abnormality. Consultation with the blood bank

physician is recommended in these situations.

Diffuse microvascular bleeding after

cardiopulmonary bypass or massive transfusion.

UCG 2010

162

 

 

 

7. Guidelines for appropriate use of blood

Platelet count and coagulation studies should be

performed prior to thetransfusion to guide

subsequent therapy. During surgery on patients

with quantitative or qualitative platelet defects,

the adequacy of hemostasis in patients should

be evaluated by the assessment of

microvascular bleeding.

Platelet transfusion should be avoided in

thrombotic thrombocytopenic purpura,

heparininduced thrombocytopenia, and post-

transfusion purpura, except in cases of life

threatening hemorrhage.

 

Issue of platelet concentrates

 

1.

It is advised to give as much as possible ABO

blood groups compatible platelets.

2.

Due to the short shelf life of platelets, they

should be kept in the laboratory as short as

possible, and must be transfused as soon as

possible.

3.

They must be stored at 20 – 24degrees under

continuous agitation.

4.

Because of the risk of bacterial contamination,

platelets must be administered via the infusion.

5.

The storage of platelets under uncontrolled

conditions e.g. at the ward should be avoided.

Dosage and administration:

 

Compatibility testing is not required. Platelet

concentrate products should be ABO identical where

possible because platelet increments may be

higher. If not possible, good clinical results are

usually obtained with ABO mismatched platelets. In

this case, transfusion of large quantities of ABO

incompatible plasma may lead to a positive direct

antiglobulin test and, rarely, clinically significant red

cell destruction. Rh compatibility is important but

 

UCG 2010

163

 

 

 

7. Guidelines for appropriate use of blood

not always possible. Post exposure prophylaxis with

anti-Rh immune globulin should be considered

following Rh-positive platelet product transfusions

to Rh-negative women who may have children in

the future.

4-5 pooled RDP. This should raise the platelet count

of a typical 70 kg man approximately 30,00050,000/

µL. Platelet count increments after

transfusion may be lower than expected in the

presence of certain medications, fever,

splenomegaly, infection, or alloimmunization to HLA

or specific platelet antigens.

 

Alternative Therapy:

 

DDAVP (Desmopressin) may improve the platelet

functional defect in uremia. It also raises von

Willebrand factor levels in mild-moderate von

Willebrand’s disease, which may improve platelet

function. Pharmacologic agents such as Aprotinin

may reduce major surgical bleeding and thereby

avoid the dilutional thrombocytopenia characteristic

of massive transfusion. Some of these agents may

also have a direct effect on improving platelet

function.

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