Indications for Platelet
Transfusion
Laura Cooling MD, MS
Associate Medical Director
Transfusion Medicine
Platelet Concentrates
Whole Blood Derived (Pooled Platelets)
Single Donor Apheresis (Pathology Approval)
• HLA (antigen negative, HLA matched)
• Crossmatched Platelets
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
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
Platelets: Two Products Available
Skimmed Platelets
• Derived whole blood
• “pooled platelets”
• 50-70 mL unit
• 5-10 x 1010 plts/unit
•  5-10K plts/unit tx
DOSE:
adult=5 units (3.7 x 1011)
infants=0.3 U/kg or 1015cc/kg BW
Single donor apheresis
• 300-350 mL unit
• 3 x 1011 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
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
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)
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)
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
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)
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
Platelet Wastage by Surgery at the UM
wastage
transport
storage
Not used
after pooling
Reasons for wastage
1. Outdate before
transfusion
2. Ordered “just in
case”, not need
3. Improper storage
4. Patient died