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Indications for Platelet Transfusion. Laura Cooling MD, MS Associate Medical Director Transfusion Medicine. Platelet Concentrates. Whole Blood Derived (Pooled Platelets) Single Donor Apheresis (Pathology Approval) HLA (antigen negative, HLA matched) Crossmatched Platelets.

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indications for platelet transfusion

Indications for Platelet Transfusion

Laura Cooling MD, MS

Associate Medical Director

Transfusion Medicine

platelet concentrates

Platelet Concentrates

Whole Blood Derived (Pooled Platelets)

Single Donor Apheresis (Pathology Approval)

HLA (antigen negative, HLA matched)

Crossmatched Platelets

platelet concentrates1
Platelet Concentrates

Biggest Inventory Problem

  • stored room temperature
  • shelf-life 5 days from collection
    • about 3 days after processing & testing
  • outdate 4 hrs after pooling
platelets product use availability dependent on market availability and cost
Platelets: Product Use/Availability Dependent on Market Availability and Cost

Whole Blood Derived

  • Majority of UM supply
  • 55,000 plts/yr

Single Donor Apheresis

  • Random, Crossmatched, HLA
  • Limited availability locally
  • UM: Requires special order, pathology approval and rigid post-transfusion monitoring
platelets two products available
Skimmed Platelets

Derived whole blood

“pooled platelets”

50-70 mL unit

5-10 x 1010 plts/unit

 5-10K plts/unit tx

DOSE:

adult=5 units (3.7 x 1011)

infants=0.3 U/kg or 10-15cc/kg BW

Single donor apheresis

300-350 mL unit

3 x 1011 plts/unit

equivalent to 5 units pooled platelets

 25-50 K plts/unit tx

DOSE:

adult=1 unit

infants=15 cc/kg

children=10 cc/kg

Platelets: Two Products Available
platelets
Platelets

Treat/prevent bleeding in patients

  • severe thrombocytopenia (ex. plt < 10-20K)
  • thrombocytopenia (<50K) and bleeding
  • Inherited platelet defects and bleeding
  • Acquired platelet defects and bleeding
platelets transfusion guidelines
Platelets: Transfusion Guidelines

Platelets < 5-10K

Prophylactic to prevent bleeding

Platelets < 20 K

Prophylactic in patients at risk for bleeding due to infection, chemotherapy, coagulopathy, etc

Platelet < 50K surgical hemostasis

Active bleeding or prior to invasive procedure

Stable, sick infant (<37 weeks)

slide8
Platelet > 100K

Extracoporeal Membrane Oxygenation (ECMO)

Neurosurgery

+/- Opthamology/airway surgery

+/- CABG surgery with microvascular bleeding despite appropriate coagulation parameters

Sick infants (< 37 wks gestation, * risk ICH)

Infant, bleeding + DIC or other abnl coagulation

Normal Platelet Count

Inherited qualitative defect (ex. Bernaud-Soulier)

Acquired defect* (ex. MoAb Anti-IIb/IIIa)

relative contraindications platelets
Relative Contraindications: Platelets
  • Thrombotic thrombocytopenia purpura (TTP)
  • Hemolytic uremic syndrome
  • Heparin-associated thrombocytopenia
  • During cardiopulmonary bypass

Prophylactic Transfusion (absence bleeding):

  • Immune thrombocytopenic purpura (ITP)
  • Alloimmune thrombocytopenia (PTP)
  • Severe HLA-alloimmunization
platelets administration
Platelets: Administration
  • ABO compatible preferred but not required
  • Transfused within 4 hrs
  • volume 50 ml/unit=250 ml/5 pooled

Dose:

Adults: 5 units pooled (raise plt 25-50K)

Children: 0.3 units/kg or 10-15 cc/kg

Rate:10 cc/min (1 unit/30 min in adult)

platelets common mistakes
Platelets: Common Mistakes
  • Over-ordering
    • 4 hr outdate from pooling!!!
  • Prior surgical/invasive procedure
    • Administering too soon (ex night before)
    • Prophylactic administration severe splenomegaly
  • Prophylactic: immune thrombocytopenia
  • Lack of appropriate post-transfusion monitoring
  • Administration within 2-4 hrs amphotericin
platelet wastage by surgery at the um
Platelet Wastage by Surgery at the UM

Reasons for wastage

1. Outdate before

transfusion

2. Ordered “just in

case”, not need

3. Improper storage

4. Patient died

Not used

after pooling

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