Att. 3
North Wales Cancer Network
Guidelines for the administration of Platelet Transfusions
Introduction
The North Wales Haematological Cancers MDT refers to two documents as the reference
source of the guidelines that describe its clinical practice,


British Journal of Haematology 2003. 122.10-23
North West Haematology Guidelines 2000 (plus updates)
The purpose of this document is to précis the key clinical cancer related
recommendations found in these two documents and present them in a more readily
available format.
Indications for Platelets

A threshold of 10x109/l is appropriate in patients with risk factors associated with
ongoing cancer treatment

A threshold of 5x109/l is appropriate in patients with no risk factors

A threshold of 20x109/l is appropriate in patients with promyelocytic leukaemia

Patients with chronic stable thrombocytopenia should have a threshold tailored
to them.
Prophylaxis for surgery

Bone marrow aspiration in patients with severe thrombocytopenia should not
normally warrant platelet transfusion

For lumbar punctures, epidurals, gastroscopy and biopsy, line insertions,
transbronchial biopsy, liver biopsy, laparotomy and similar procedures platelets
should be 50x109/l as a minimum.

For operations in critical sites such as the brain and eyes platelets should be
raised to 100x109/l
Administration of platelets

A single unit of platelets should be administered over 30 mins

Pulse, BP and temperature should be performed before each transfusion and 15
mins after the commencement of each transfusion. The same recordings should
also be taken at the end of the complete transfusion.
Management of adverse side effects

If a transfusion reaction is suspected the transfusion should be stopped
immediately and medical staff informed

Further management depends on the type and severity of the reaction

Premedication with hydrocortisone and/or chlorpheniramine should not be used
routinely before platelet transfusions
Irradiation of platelets
Irradiated platelets should be given to the following,

All allograft recipients from commencement of conditioning therapy (or 7 days
prior to autologous back up harvesting, whichever is sooner) until 1 year after
transplant (longer if chronic GVHD)

All donors for allograft recipients from 7 days prior to donation until completion
of the harvest

All autograft recipients from 7 days prior to harvesting until completion, then 7
days prior to transplant until six months post transplant

All patients with Hodgkins disease indefinitely

All patients treated at any stage with purine nucleoside analogues
(fludarabine,cladribine, pentostatin) indefinitely

All LHA selected or directed donations
CMV Negative Products
CMV is a major pathogen in the post transplant setting and all efforts should be made to
avoid exposure of the patients to the virus through the use of unscreened, potentially
CMV+ blood products.

All BMT patients should be CMV tested

CMV – patients should receive CMV – products only

CMV + patients be received unscreened products though ideally they too should
receive CMV – products.