Platelet Transfusions Indications, dose and administration Indications for platelet transfusions Decision to transfuse should be based on both laboratory investigations and assessment of the clinical condition with careful consideration of risks & benefits. Platelet transfusion is not indicated in all cases of thrombocytopenia and may be contraindicated (e.g. immune thrombocytopenia, thrombotic thrombocytopenia and heparin induced thrombocytopenia). Dosing recommendations Platelet dose is generally 5 to 10ml/kg. Usual platelet dose in an adult is 1 adult unit. “Don’t use 2 when 1 will do” Avoid giving excess volume to neonates, infants and small children. Blood bank will supply the most appropriate unit in stock. Platelet Indication Platelet count Oncology Chemotherapy, haemopoetic stem cell transplantation <10 x 10^9/L Chemotherapy, haemopoetic stem cell transplantation & risk factors (e.g. fever, minor bleeding) <20 x 10^9/L Lumbar puncture and new disease induced thrombocytopenia <50 x 10^9/L Lumbar puncture and on-going chemotherapy induced thrombocytopenia <30 x 10^9/L Invasive procedures Patient undergoing invasive procedure Patient undergoing high risk invasive procedure (e.g. neuro surgery) <100 x 10^9/L Critically ill patients - limited evidence, suggested thresholds: Note: higher transfusion triggers may be acceptable in certain circumstances No bleeding No bleeding & risk factors (e.g. sepsis, renal failure, medications) Extra Corporeal Life Support (lower platelet counts may be acceptable in stable patients) Active bleeding Neonatal thrombocytopenia <30-50 x 10^9/L It may be that only a portion of the pack/unit will be administered or multiple pedipaks will be supplied if an adult unit is not available. <10 kg 10-20 kg 20-30 kg 30-40 kg >40 kg Pooled platelets (adult unit) 5ml/kg to 10ml/kg 1 unit or 10ml/kg Which ever is less 1 unit Apheresis platelets (adult unit) Paediatric apheresis platelets (pedipak) 1 pedipak or 5 - 10 ml/kg Which ever is less 2 pedipaks or 5 - 10 ml/kg Which ever is less 3 pedipaks or 5 - 10 ml/kg Which ever is less 4 pedipaks or Weight Platelet product All platelet products are leucocyte depleted and irradiated Stored at room temperature, never in fridge Shelf life 5 days Platelet products, volume and expected platelet increment Product Description Volume Expected platelet increment Pooled platelets (adult unit) Platelets collected from 4 separate donors and pooled into 1 unit >160 ml. Average 326 ml 1 unit typically increases count by 20 - 40 x 10^9/L in 70 kg adult Apheresis platelets (adult unit) Single donor platelets, suspended in donor’s plasma Can be used to decrease donor exposure in patients frequently transfused. 100–400 ml. Average 180 ml Paediatric apheresis platelets (pedipak) Single donor platelets split into 3 to 4 packs (pedipaks) of equal volume Can be used to reduce donor exposure and minimise product wastage 40–60 ml. Average 51 ml 1 pedipak typically increases count in 18kg child by 20 x 10^9/L Platelet administration Use new blood administration filter (170 to 200 micron) when administering platelets. Use a volumetric pump or syringe driver whenever possible Do not transfuse platelets via same blood administration filter after red cell transfusion as some platelets may get caught in fibrin strands/debris caught in filter. (Exception – critical bleeding. Can continue to use same filter unless flow is impeded by debris caught in filter). Suggest administer over 1 to 2 hours. Increased transfusion rates may be associated with increased risk of transfusion reactions. Must be completed within 4 hours.