Platelets

Component Description

For all platelets

• Storage for five days at 20 - 24°C with gentle agitation on a platelet shaker
• DO NOT refrigerate.

Types of Platelet Products

Indications for Use

Treatment or prevention of bleeding due to:

• Severely decreased platelet production
• Functionally abnormal platelets

May be used in treating some patients with platelet consumption or dilutional thrombocytopenia

May be useful prophylactically to patients with low or falling platelets counts (usually <10 x 10^9/L secondary to chemotherapy)

Not usually effective or indicated in patients with rapid platelet destruction

May be used perioperatively when platelet count is <50 x 10^9/L (see NHMRC/ANZSBT Guidelines).

Precautions

• Consider the need for platelets. Is a platelet transfusion required? NHMRC/ASBT guidelines
• Caution is needed with volume
• Note: An IV blood giving set used for red cells should never be subsequently used for platelets since red cell debris trapped in the filter will trap platelets, however red cells can be transfused through an IV line following platelets.

Compatibility

TESTING – blood group on record.

ABO

• ABO identical platelets are preferred
• However ABO non-identical platelets may be issued to patient by the Transfusion Service Provider when ABO identical platelets are unavailable. In some patients (particularly children), plasma present in platelet units which are ABO-incompatible with the recipient's red cells may cause a positive direct antiglobulin test and possible low-grade haemolysis due to isoagglutinins present in the plasma.
• In some circumstances the need for special requirements such as HLA matching may be more important than providing the same ABO blood group.

• Rh(D) negative platelets can be given to Rh(D) positive patients
• If Rh(D) positive platelets are given to Rh(D) negative patients, the use of Rh(D) Immunoglobulin (Anti D) may be required – consult treating medical officer / haematologist / transfusion service provider.

Dosage and Administration

Transfusion Set-Up

Note: this is a guide only – individual hospital guidelines should be followed.

• Compatibility testing is not required routinely. Platelets should be ABO and Rh(D) type compatible
• Administer through a new IV blood giving set incorporating a 170-200 micron filter (large particle filter which only removes aggregates and other large particles)
• For platelets requiring bedside leucodepletion(i.e platelet components that have not been pre-storage leucocyte depleted), a white cell filter is required. These filters are designed to remove small particles such as white cells but allow red cells, platelets and proteins to go through. Specific set-up is required – see product inserts and talk to your local Transfusion/Haematology Nurse Consultant or Transfusion Service provider. Do not ‘flush’ these filters after use
• Units labelled as leucodepleted product do not require a white cell filter at the bedside BUT still require a standard blood administration set incorporating a 170-200 micron filter (see above).

Consider

• If Rh(D) positive platelets are given to an Rh(D) negative female of child bearing potential, prevention of immunisation using Rh(D) immunoglobulin should be considered
• Dose is 250IU Rh(D) immunoglobulin per therapeutic dose given
• Refractory patients may require ABO matched apheresis or HLA selected platelets – contact ARCBS to arrange.

Patient Monitoring

Check patient vital signs (pulse rate, respiration rate, blood pressure and temperature) at the start of transfusion AND at least after 15 minutes, at the end of the transfusion AND if there is ANY reaction. Record observation in patient’s notes.

When to Transfuse

• Plan ALL transfusions during business hours. Emergency transfusions should be the only transfusions given after hours
• Transfuse ONE dose at a time.

How Long Should a Transfusion Take?

• For the first 15 minutes the rate should be no more than 5mLs/minute, unless otherwise clinically indicated
• Each unit must be transfused within four hours of starting
• May be given faster in acute bleeding situations.