Indications for Platelet Transfusion Laura Cooling MD MS

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 m. L unit • 5 -10 x 1010 plts/unit • 5 -10 K plts/unit tx DOSE: adult=5 units (3. 7 x 1011) infants=0. 3 U/kg or 1015 cc/kg BW Single donor apheresis • 300 -350 m. L 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 -20 K) • thrombocytopenia (<50 K) and bleeding • Inherited platelet defects and bleeding • Acquired platelet defects and bleeding

Platelets: Transfusion Guidelines Platelets < 5 -10 K Prophylactic to prevent bleeding Platelets < 20 K Prophylactic in patients at risk for bleeding due to infection, chemotherapy, coagulopathy, etc Platelet < 50 K surgical hemostasis Active bleeding or prior to invasive procedure Stable, sick infant (<37 weeks)

Platelet > 100 K 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. Mo. Ab 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 -50 K) 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 Not used after pooling Reasons for wastage 1. Outdate before transfusion 2. Ordered “just in case”, not need 3. Improper storage 4. Patient died