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Home | Articles | Haematology and Thrombosis | Platelet Transfusion

Platelet Transfusion

Last updated 2nd December 2021

Introduction

  1. Platelets play a primary role in haemostasis i.e. the prevention of bleeding.
  2. The normal range for the platelet count in peripheral blood at all ages is 150 – 400 x109/L.
  3. This does not, however, tell you anything about platelet function and in certain circumstances platelets may be needed even though the count is normal.

What’s in a Bag of Platelets

  1. Pooled platelets are harvested by centrifuging whole blood from several donors
  2. Apheresis platelets are collected from a single donor
  3. One pack (apheresis or pooled) is termed one Adult Therapeutic Dose (ATD)
  4. One ATD should increase the platelet count by at least 20×109/L.  This can be checked 10 minutes after the transfusion has completed
  5. If the increase is persistently below 20×109/L this may suggest refractoriness.
  6. All blood services in the UK screen for bacterial contamination routinely.
  7. Platelets expire 7 days after pooling

Indications for Platelet Transfusion

  1. Most platelets are given to prevent rather than to treat bleeding when the platelet count is less than or equal to 10×109 or between 10 and 20×109/L if there are additional risk factors for bleeding.
  2. Absolute thrombocytopenia, in the absence of any abnormality, is unlikely to be complicated by serious spontaneous haemorrhage if the count remains above 5×109/L.
  3. Platelets are given to prevent bleeding (prophylactic) in the following clinical situations:
    • Reversible bone marrow failure including allogeneic stem cell transplant and critical illness
    • Chronic bone marrow failure if patient is receiving intensive treatment or to prevent persistent bleeding
  4. Prophylactic platelet transfusions may not be required if patient is well and is having an autologous stem cell transplant.
  5. Prophylactic platelet transfusions are not required if patient has chronic bone marrow failure and is stable and well.
  6. Platelet transfusions are also given to prevent bleeding prior to an invasive procedure.
  7. Platelet transfusions are given to treat bleeding when WHO bleeding grade is 2 or above:
    • Grade 1 – no bleeding
    • Grade 2 – petechiae
    • Grade 3 – mild blood loss
    • Grade 4 – gross blood loss
    • Grade 5- debilitating blood loss
  8. Note that in some conditions platelets can be contra-indicated – see table below.
Prophylactic Platelet Transfusion – No Procedure
Reversible Bone Marrow Failure (BMF) including allogeneic stem cell transplantation10x109/L
Reversible BMF with autologous stem cell transplantation (consider no prophlaxis)10x109/L
Critical illness10x109/L
Chronic BMF receiving intensive therapy10x109/L
Chronic BMF to prevent persistent bleeding of grade 2Count variable
Chronic stable BMF, abnormal platelet function, platelet consumption/destruction (e.g. DIC, TTP) or immune thrombocytopenia (ITP, HIT, PTP)Not indicated
Presence of risk factors for bleeding (e.g. sepsis, antibiotic treatment, abnormalities of haemostasis)10-20x109/L
Reversible/chronic bone marrow failure/critical care10-20x109/L
Abnormal platelet function, platelet consumption/destruction, immune thrombocytopeniaNot indicated
Platelet Transfusion – Pre Procedure
Central venous catheter (CVC) excluding PICC line20x109/L
Lumbar puncture40x109/L
Percutaneous live biopsy50x109/L
Major surgery50x109/L
Epidural anaesthesia, insertion & removal80x109/L
Neurosurgery or phthalmic surgery involving posterior segment of the eye100x109/L
Bone marrow aspirate or trephine biopsies, PICC line insertion, traction removal of central venous catheters (CVCs), cataract surgeryNot indicated
Therapeutic Use - Bleeding WHO Grade 2 or Above
Severe bleeding50x109/L
Multiple trauma, brain or eye injury, spontaneous intracerebral haemorrhage100x109/L
Bleeding (WHO Grade 2) but not severe30x109/L

Links

Summary of Guidelines for Use of Platelet Transfusions from BSH Guideline 2016 [pdf]