Platelet transfusion

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General

Adult Dosing

Thrombocytopenia

  • 1 unit raises count by 50,000

Pediatric Dosing

Special Populations

  • Pregnancy Rating:
  • Lactation:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Leukocyte Irradiated and Reduced (Depleted) Blood Products[1]

  • Leukocyte reduced: Prevents sensitization in patients who may require bone marrow transplant
  • Irradiated: Eliminates capacity of T-cells to proliferate (prevents Transfusion-associated graft-versus-host disease)
  • If tranfusion required for crashing patient, do not delay tranfusion of uncrossed blood to irradiate products beforehand
  • Requires minimum 25 Gy irradiation, not to exceed 50 Gy for all:
    • Packed red cells
    • Platelets
    • Granulocyte components, regardless of immunocompetency
    • First or second degree relatives, regardless of immunocompetency
    • HLA-selected components, regardless of immunocompetency
  • Irradiated products should be administered shortly after irradiation
  • Those products not used for intended recipient may be returned safely to stock for others not requiring irradiated components, though with reduced shelf life
  • Not necessary to irradiate FFP, cryoprecipitate, fractioned plasma products
Generally Accepted Indications For Irradiated Blood Products[2][3]
  • Immunocompromised stem cell recipients
  • Organ transplant recipients
  • Patients undergoing marrow transplantation
  • Intrauterine transfusion
  • Neonatal exchange transfusions
  • Premature and low birthweight neonates
  • Hodgkin lymphoma
  • Congenital cell-mediated immunodeficiencies (DiGeorge, Wiskott-Aldrich, Leiner's, 5'-nucelotidase deficiency)
  • Acquired immunodeficiencies to include:
    • Leukemia, CLL
    • Aplastic anemia
    • Neutropenia
  • Patients receiving:
    • Purine analogue chemotherapies (fludarabine, cladribine, deoxycoformicin, bendamustine, clofarabine, etc.)
    • Certain biologic immunosuppresants (alemtuzumab)
  • Donations from biologic relatives
  • Donations from HLA-matched donors
  • Genetically homogenous populations
  • Probably indicated int:
    • Hematologic malignancies other than Hodgkin lymphoma
    • Solid tumors treated with cytotoxic agents
Indications For Leukoreduced Blood Products[4]
  • Chronically transfused
  • Cardiac surgery
  • Solid organ or stem cell transplant recipients, before and after
  • Previous febrile nonhemolytic transfusion reactions
  • CMV seronegative patients at risk

Not Routinely Needing Irradiated Products

  • HIV, AIDS
  • Concurrent, non-severe common viral infection
  • Rituximab treatment
  • Routine solid organ transplant
  • Routine infant cardiac surgery

Indications

Platelet Transfusion Thresholds

most if not all of the following thresholds are based on weak recommendations with low quality evidence[5]

  • <50K if planned lumbar puncture or neurosurgical procedure[6]
  • <20K if planned for central venous catheter placement (preference toward compressible site), or febrile patient
  • <10K in asymptomatic patients (unless due to ITP, TTP, or HIT)

There are no firm recommendations for transfusion thresholds in acute traumatic bleeding but many providers will opt for a goal of 100K, especially if there is evidence of ICH

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life:
  • Metabolism:
  • Excretion:
  • Mechanism of Action:

Comments

  • Transfusion should be type specific because platelets are bathed in plasma
    • Non-type specific platelets can be used but results in higher rate of complications
  • Like pRBCs, platelets can be leukocyte reduced or washed
  • A 6-pack of platelets will raise the count by 40,000 to 60,000[7]

See Also

References

  1. Treleaven J et al. Guidelines on the use of irradiated blood components: Prepared by the BCSH Blood Transfusion Task Force. British Society for Haematology. Jan 2013. http://www.bcshguidelines.com/documents/irrad_bcsh_072010.pdf
  2. Guidelines on the use of irradiated blood components prepared by the British Committee for Standards in Haematology blood transfusion task force. Treleaven J, Gennery A, Marsh J, Norfolk D, Page L, Parker A, Saran F, Thurston J, Webb D. Br J Haematol. 2011;152(1):35.
  3. 2.AABB Technical Manual, 17th ed, Roback JD, Grossman BJ, Harris T, et al, (Eds). American Association of Blood Banks Press, Bethesda 2011. p.755.
  4. The reintroduction of nonleukoreduced blood: would patients and clinicians agree? Rosenbaum L, Tomasulo P, Lipton KS, Ness P. Transfusion. 2011 Dec;51(12):2739-43. Epub 2011 May 26.
  5. Kaufman, R. et al. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Annals of Internal Medicine. 2015. Vol 162. No. 3 205-214 Full Text
  6. Shuoyan, N. et al. Safety of Lumbar Punctures in Adult Oncology Patients with Thrombocytopenia. Blood 2015 126:1141
  7. Osterman JL and Arora S. Blood product transfusions and reactions. Emerg Med Clin North Am. 2014; 32(3):727-738.