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Use of platelets

Submitted by admin on Tue, 2010-03-02 16:40

Indications

Therapeutic platelet transfusion

Acceptable indications
Platelet threshold
Thrombocytopenia with clinically significant bleeding [a]
<30 x 109/L
Thrombocytopenia with severe bleeding [b]
<50 x 109/L
Thrombocytopenia with bleeding at critical sites [c]
≤100 x 109/L
Congenital or acquired functional platelet defects
Platelet counts are not a reliable indicator
Disseminated Intravascular Coagulopathy (DIC)
Aim for >50 x 109/L
Immune thrombocytopenia (ITP), Thrombotic thrombocytopenia purpura (TTP), Heparin-induced thrombocytopenia (HIT)
<20 x 109/L (only if bleeding)
Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) with intracranial bleeding
<100 x 109/L
Fetal and Neonatal Alloimmune Thrombocytopenia (FNAIT) with other bleeding
<50 x 109/L

[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.

Phrophylactic platelet transfusion for prevention of bleeding

Acceptable indications
Platelet threshold
Neurosurgery
<100 x 109/L
Invasive procedures
<50 x 109/L
Vaginal or caesarean birth
<50 x 109/L
Central venous catheter (CVC) insertion (elective) (8)
<20 x 109/L
Critically ill patients
<20 x 109/L
Chemotherapy or haematopoietic stem cell therapy (HSCT) with risk factors
<20 x 109/L
Chemotherapy or haematopoietic stem cell therapy (HSCT) without risk factors
<10 x 109/L
Preterm and low birthweight infants
<20 x 109/L
Preterm neonate with FNAIT
<50 x 109/L
Term neonate  with FNAIT
<30 x 109/L

Contraindications

  • 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)

Dosage

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.

Possible alternatives (7)

General measures
 
Apply pressure after superficial procedures
Treat surgical causes of bleeding
Minimally invasive surgery where possible
Stop anti-platelet agents where possible
Consider tranexamic acid
 
 
Specific measures
 
Patient population
Alternative
Liver disease
Vitamin K
Uraemia
Dialysis, correct HCT to 30%, consider DDVAP
Inherited platelet function disorders
Specialist advice required. Consider DDAVP
Splenomegaly/hypersplenism
Consider splenectomy or splenic irradiation
 
Reference
  1. National Blood Authority. Patient Blood Management Guidelines: Module1 – Critical Bleeding Massive Transfusion. Australia, 2012. https://www.blood.gov.au/pbm-module-1
  2. National Blood Authority. Patient Blood Management Guidelines: Module 2 – Perioperative. Australia, 2012. https://www.blood.gov.au/pbm-module-2
  3. National Blood Authority. Patient Blood Management Guidelines: Module 3 – Medical. Australia, 2012. https://www.blood.gov.au/pbm-module-3
  4. National Blood Authority. Patient Blood Management Guidelines: Module 4 – Critical Care. Australia, 2012. https://www.blood.gov.au/pbm-module-4
  5. National Blood Authority. Patient Blood Management Guidelines: Module 5 – Obstetrics and Maternity. Australia, 2015. https://www.blood.gov.au/pbm-module-5
  6. National Blood Authority. Patient Blood Management Guidelines: Module 6 – Neonatal and Paediatrics. Australia, 2016. https://www.blood.gov.au/pbm-module-6
  7. 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
  8. 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
  9. 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/
Updated on 7 February, 2018