Platelets are indicated for the prevention and treatment of haemorrhage in patients with thrombocytopenia or platelet function defects. The cause of the thrombocytopenia should be established before a decision to transfuse plateles is made. All platelet transfusions should be guided by a platelet count taken within the previous 48 hours. The decision to administer platelets must be made following discussion with a Consultant Haematologist of the Week (HOW) on bleep 922.
Platelets are used in 2 distinct situations:-
The table below shows indications and thresholds for platelet transfusions based on the underlying reason for the thrombocytopenia.
Indications | Threshold |
Reversible bone marrow failure |
|
- Receiving intensive chemotherapy |
10 x 10^9/L |
- Undergoing allogeneic stem cell transplant |
10 x 10^9/L |
- Undergoing autologous stem cell transplant |
Not indicated |
- Additional risk factors for bleeding |
20 x 10^9/L |
- Bleeding of WHO grade 2 or above |
50 x 10^9/L |
Chronic bone marrow failure (including Aplastic Anaemia and myelodysplastic syndromes) |
|
- Low dose chemotherapy or azacitidine | Not indicated |
- Receiving ATG | ? |
- Receiving intensive chemotherapy |
10 x 10^9/L |
- Chronic bleeding of WHO grade 2 or above | Individual plan |
Critical illness |
|
- In absence of bleeding | 10 x 10^9/L | Prophylactic use pre procedure |
- Venous central lines | 20 x 10^9/L |
- Lumber puncture |
40 x 10^9/L |
- Major surgery or Percutaneous liver biopsy | 50 x 10^9/L |
- Epidural anaesthesia- | 80 x 10^9/L |
Therapeutic use | |
Bleeding that is not considered severe or life threatening |
30 x 10^9/L |
Major haemorrhage | 50 x 10^9/L |
On-going bleeding | 100 x 10^9/L |
Multiple trauma or spontaneous intracerebral haemorrhage |
The dose is one pool of platelets (adult therapeutic dose). Following transfusion of one pool, symptoms should be reassessed and a platelet count should be taken to establish the benefits of the transfusion and if further platelets are required.
If there is a small or no increase in platelet count (increment) following several platelet transfusions contact the Haematology Consultant for advice (HOW bleep 922)
All requests, with the exception of major haemorrhage and established haematology patients, must go through the Consultant Haematologist on bleep 922 during routine working hours or through switchboard out-of-hours. The Transfusion laboratory must be contacted once authority for use of Platelets has been obtained.
Platelet requests should be made 24 hours in advance and no later than 09:00 as they are not kept in stock in the Transfusion Laboratory.
All requests must go through the transfusion laboratory. The following information must be given:-
Prior to first administration of platelets blood samples should be taken for:-
Prior to subsequent administration of platelets blood samples should be taken for:-
Platelets should ideally be ABO and RhD identical with the patient. However platelets of another ABO group may be administered if the correct ABO group is unavailable. If RhD positive platelets are given to a Rhesus negative woman <60 years of age, 250iu of anti-D should be administered within 72 hours.
Platelets may need to be irradiated. Patients who have HLA antibodies or are refractory to random platelets may require HLA selected platelets.
One pool of platelets is available for emergency use throughout the whole Trust