[a] Clinically significant bleeding e.g. prolonged epistaxis, extensive skin bleeding, haematemesis, melaena, WHO grade 2.
[b] Severe bleeding e.g. bleeding that requires a RBC transfusion, WHO grade 3-4.
[c] Critical sites e.g. CNS, eyes.
- Bleeding unrelated to decreased numbers of platelets or abnormally functioning platelets.
- Destruction of endogenous and exogenous platelets, such as in immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome or heparin-induced thrombocytopenia (HIT), unless the patient has life-threatening haemorrhage.
- Chronic bone marrow failure (7)
- The prophylactic use of platelets after cardiac surgery is not supported (2,8)
The usual dose in an adult patient is 1 unit (apheresis) or 1 pool (pooled).
One unit (one standard adult dose) of Platelets Apheresis or Pooled Leucocyte Depleted would be expected to increase the platelet count of a 70 kg adult by 20–40 x 109/L.
The suggested dose in neonates and infants is 10 mL/kg
One unit of Platelets Paediatric Apheresis Leucocyte Depleted would be expected to increase the platelet count of an 18 kg child by 20 x 109/L.
Do not routinely transfuse more than a single dose of platelets
Consider giving more than a single dose in patients with severe thrombocytopenia who are bleeding in a critical site
Reassess patient’s clinical condition and check PLT count after each PLT transfusion; give further doses if needed
For prophylaxis, doses may need to be repeated in 1–3 days because of the short life span of transfused platelets.
Immune and non-immune mechanisms may contribute to reduced platelet recovery and survival.
Reference
- National Blood Authority. Patient Blood Management Guidelines: Module1 – Critical Bleeding Massive Transfusion. Australia, 2012. https://www.blood.gov.au/pbm-module-1
- National Blood Authority. Patient Blood Management Guidelines: Module 2 – Perioperative. Australia, 2012. https://www.blood.gov.au/pbm-module-2
- National Blood Authority. Patient Blood Management Guidelines: Module 3 – Medical. Australia, 2012. https://www.blood.gov.au/pbm-module-3
- National Blood Authority. Patient Blood Management Guidelines: Module 4 – Critical Care. Australia, 2012. https://www.blood.gov.au/pbm-module-4
- National Blood Authority. Patient Blood Management Guidelines: Module 5 – Obstetrics and Maternity. Australia, 2015. https://www.blood.gov.au/pbm-module-5
- National Blood Authority. Patient Blood Management Guidelines: Module 6 – Neonatal and Paediatrics. Australia, 2016. https://www.blood.gov.au/pbm-module-6
- Padhi S, Kemmis-Betty S, Sharangini R, Hill J, Murphy MF. Blood transfusion: summary of NICE guidance. BMJ 2015;351:h5832 http://www.bmj.com/content/351/bmj.h5832
- Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2015;162:205-213. http://annals.org/article.aspx?articleid=1930861
- Platelet transfusion: principles, risks, alternatives and best practice. NCA Platelet Working Group. NHS Blood and Transplant, 2012. http://hospital.blood.co.uk/patient-services/patient-blood-management/platelet-resources/