1. Indications for Platelet Transfusion Laura Cooling MD, MS Associate Medical Director Transfusion Medicine

2. Platelet Concentrates Whole Blood Derived (Pooled Platelets) Single Donor Apheresis (Pathology Approval) HLA (antigen negative, HLA matched) Crossmatched Platelets

3. 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

4. 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

5. Platelets: Two Products Available Skimmed Platelets Derived whole blood “pooled platelets” 50-70 mL unit 5-10 x 10 10 plts/unit  5-10K plts/unit tx DOSE: adult=5 units (3.7 x 10 11 ) infants=0.3 U/kg or 10- 15cc/kg BW Single donor apheresis 300-350 mL unit 3 x 10 11 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

6. 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

7. 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)

8. 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)

9. 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

10. 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)

11. 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

12. Platelet Wastage by Surgery at the UM Not used after pooling Reasons for wastage 1. Outdate before transfusion 2. Ordered “just in case”, not need 3. Improper storage 4. Patient died