Facts About Platelet Transfusion
Dr. MuKeSh M. DeSaI. M.D.
HaEmAtOlOgY & ImMuNoLoGy CeLl
Consultant Hematologist & Oncologist & Immunologist
Sir Harkisondas Nurrotamdas Hospital
Balbhai Nanavati Hospital
Chief Division of Immunology
Prof of Pediatric Hematology & Oncology
Department of Pediatric Hematology Oncology
Bai Jerbai Wadia Hospital For Children; Mumbai.
e mail: mmdesai007@gmail.com
FACTS ABOUT PLATELET TRANSFUSION:
are prepared from donated blood with in 4 to 6 hrs of collection by centrifugation & It contains approximately 5.5 x 1010 platelets.
are prepared by platelet Aphaeresis machine
§ One unit of SDP is equivalent to 5 to 10 units of RDP.
22 0 C on a constant agitator.
DO NOT STORE PLATELETS IN THE REFRIGERATOR.
Few hrs to maximum 24 hrs. This depends on whether the patient is bleeding or not.
§ One unit of platelet RDP increases platelet count by approximately 5 x 109/L (i.e. 5000 / mm3).
§ SDP is as effective as RDP.
§ SDP is more expensive & its use should be limited to cases of platelet refractoriness & in limiting donor exposure.
§ Adults: 1 unit RDP for every 10 Kg increases platelet count by approximately 50 x 109/L (50,000 / mm3).
§ Pediatric : 0.2 unit / kg of RDP will raise the platelet count to 50 x 109/L (50,000 / mm3.)
§ Normal platelets express ABO antigens on their surface. They do not express Rh D antigen.
§ RDP of the same Blood group is recommended; in case of an emergency RDP of any blood group can be administered.
§ Rh-negative women in reproductive age group should receive Rhogam (Anti D) if they receive RDP from an Rh + ve donor, to prevent Rh sensitization from contaminating RBCs.
§ SDP donor should be of the same blood group.
DECISION MAKING IN PLATELETS TRANSFUSIONS
§ Clinical condition of patient
§ Cause of thrombocytopenia
§ Platelet count & function.
§ Treating physician experience & comfort level.
§ Risk of life threatening hemorrhage is approximately 1 %.
§ Risk of bleeding increases with concomitant secondary infection, fever, DIC, Amphotericin B Therapy & Drugs like NSAID'S.
§ Platelet transfusions are not indicated for skin bleed like petechiae, purpura, and ecchymosis.
§ A good dictum to follow in patients of Thrombocytopenia is
"If the patient is not bleeding do not Transfuse platelets".
§ Is suggested in a patient with thrombocytopenia without any bleeding when the platelet count is < 5 x 10 9/L (5000/mm3). (*NOTE: Not applicable for ITP)
§ The threshold for prophylactic platelet Transfusion has been lowered from the previous threshold of 20 x 10 9/L (20,000/mm3) platelet count.
§ In case of associated sepsis, DIC, fever or Amphotericin B therapy transfuse at < 10 x 10 9/L (10,000/mm3)
is given in a patient with thrombocytopenia if there is life threatening bleed like
§ Intracranial hemorrhage
§ Hematemesis, malena
§ Severe profuse gum bleeding,
§ Severe menorrhaegia.
§ Emergency Surgery in a patient with thrombocytopenia with platelets < 30 x 10 9/L (30,000/ mm3) ; raise platelet count to atleast > 50 x 109/L (50,000 / mm3) before surgery.
CONTRAINDICATIONS FOR PLATELET TRANSFUSIONS:
§ Platelet Transfusions are inappropriate in ITP as survival of transfused platelets is very brief, as short as few minutes.
§ Heparin induced thrombocytopenia (HITT).
§ Thrombotic thrombocytopenic purpura (TTP).
HAZARDS OF PLATELET TRANSFUSION:
§ Due to the storage temperature of 22 0 C There is higher risk of febrile non-hemolytic transfusion reactions (FNHTR). & Bacterial contamination.
§ Transmission of viral infections like HbsAG, HCV, HIV, HAV, Parvovirus.
ADMINISTRATION OF PLATELETS:
§ Procure platelets from the blood bank only prior to transfusion.
§ Infuse platelet immediately upon arrival to the hospital.
§ DO NOT STORE PLATELETS IN HOSPITAL REFRIGERATOR.
§ Administer Platelets through a separate IV line
§ Do not routinely give pre transfusion medications.
§ Check patient's vital parameters before starting platelet transfusion.
§ Begin with a slow infusion rate; if there is no reaction infuse rapidly so as to complete all platelets with in an hour.
§ Monitor the patient's vital parameters through out infusion.
§ Check platelet count 1 hr and 24 hrs after Transfusion to judge adequacy of platelet transfusion.
§ Use a blood transfusion filter set with an in line filter;
§ Leucodepletion filter sets specific for platelet Transfusion are available and should be used in an affording patient.
§ Leucodepletion filter removes viable leucocytes and prevents;
¨ FNHTR,
¨ Transmission of CMV infection &
¨ Delays platelet refractoriness.
¨ Leucodepletion however do not prevent TaGvHD (Transfusion associated Graft versus Host disease)
§ Irradiating platelets before infusion can prevent TaGvHD.
PLEASE NOTE:
Risk of life threatening Bleeding in case of thrombocytopenia is approximately 1%
Avoid drugs like NSAID's
Treat the patient and not the platelet count.
if the patient is not bleeding do not transfuse platelets
FFP is not a substitute for platelets
please spread the message about platelet transfusion.
Remember no blood or blood product transfusion is 100% safe.