Use of platelets

Acceptable indications
Platelet threshold
Thrombocytopaenia with clinically significant bleeding [a]
<30 x 109/L
Thrombocytopaenia with severe bleeding [b]
<50 x 109/L
Thrombocytopaenia with bleeding at critical sites [c]
≤100 x 109/L
Congenital or acquired functional platelet defects
Platelet counts are not a reliable indicator
Disseminated Intravascular Coagulopathy (DIC)
Aim for >50 x 109/L
Immune thrombocytopenia (ITP), Thrombotic thrombocytopenia purpura (TTP), Heparin-induced thrombocytopenia (HIT)
<20 x 109/L (only if bleeding)
Fetal and Neonatal Alloimmune Thrombocytopaenia (FNAIT) with intracranial bleeding
<100 x 109/L
Fetal and Neonatal Alloimmune Thrombocytopaenia (FNAIT) with other bleeding
<50 x 109/L

[a] Clinically significant bleeding e.g. prolonged epistaxis, extensive skin bleeding, haematemesis, melaena, WHO grade 2.

[b] Severe bleeding e.g. bleeding that requires a RBC transfusion, WHO grade 3-4.

[c] Critical sites e.g. CNS, eyes.

Acceptable indications
Platelet threshold
Neurosurgery
<100 x 109/L
Invasive procedures
<50 x 109/L
Vaginal or caesarean birth
<50 x 109/L
Central venous catheter (CVC) insertion (elective) (8)
<20 x 109/L
Critically ill patients
<20 x 109/L
Chemotherapy or haematopoietic stem cell therapy (HSCT) with risk factors
<20 x 109/L
Chemotherapy or haematopoietic stem cell therapy (HSCT) without risk factors
<10 x 109/L
Preterm and low birthweight infants
<20 x 109/L
Preterm neonate with FNAIT
<50 x 109/L
Term neonate  with FNAIT
<30 x 109/L
  • Bleeding unrelated to decreased numbers of platelets or abnormally functioning platelets.
  • Destruction of endogenous and exogenous platelets, such as in immune thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), haemolytic uraemic syndrome or heparin-induced thrombocytopenia (HIT), unless the patient has life-threatening haemorrhage.
  • Chronic bone marrow failure (7)
  • The prophylactic use of platelets after cardiac surgery is not supported (2,8)

The usual dose in an adult patient is 1 unit (apheresis) or 1 pool (pooled).

One unit (one standard adult dose) of Platelets Apheresis or Pooled Leucocyte Depleted would be expected to increase the platelet count of a 70 kg adult by 20–40 x 109/L.

 

The suggested dose in neonates and infants is 10 mL/kg

One unit of Platelets Paediatric Apheresis Leucocyte Depleted would be expected to increase the platelet count of an 18 kg child by 20 x 109/L.

Do not routinely transfuse more than a single dose of platelets

Consider giving more than a single dose in patients with severe thrombocytopaenia who are bleeding in a critical site

Reassess patient’s clinical condition and check PLT count after each PLT transfusion; give further doses if needed

For prophylaxis, doses may need to be repeated in 1–3 days because of the short life span of transfused platelets.

Immune and non-immune mechanisms may contribute to reduced platelet recovery and survival.

General measures
 
Apply pressure after superficial procedures
Treat surgical causes of bleeding
Minimally invasive surgery where possible
Stop anti-platelet agents where possible
Consider tranexamic acid
 
 
Specific measures
 
Patient population
Alternative
Liver disease
Vitamin K
Uraemia
Dialysis, correct HCT to 30%, consider DDVAP
Inherited platelet function disorders
Specialist advice required. Consider DDAVP
Splenomegaly/hypersplenism
Consider splenectomy or splenic irradiation
 
Reference
  1. National Blood Authority. Patient Blood Management Guidelines: Module1 – Critical Bleeding Massive Transfusion. Australia, 2012. https://www.blood.gov.au/pbm-module-1
  2. National Blood Authority. Patient Blood Management Guidelines: Module 2 – Perioperative. Australia, 2012. https://www.blood.gov.au/pbm-module-2
  3. National Blood Authority. Patient Blood Management Guidelines: Module 3 – Medical. Australia, 2012. https://www.blood.gov.au/pbm-module-3
  4. National Blood Authority. Patient Blood Management Guidelines: Module 4 – Critical Care. Australia, 2012. https://www.blood.gov.au/pbm-module-4
  5. National Blood Authority. Patient Blood Management Guidelines: Module 5 – Obstetrics and Maternity. Australia, 2015. https://www.blood.gov.au/pbm-module-5
  6. National Blood Authority. Patient Blood Management Guidelines: Module 6 – Neonatal and Paediatrics. Australia, 2016. https://www.blood.gov.au/pbm-module-6
  7. Padhi S, Kemmis-Betty S, Sharangini R, Hill J, Murphy MF. Blood transfusion: summary of NICE guidance. BMJ 2015;351:h5832 http://www.bmj.com/content/351/bmj.h5832
  8. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med. 2015;162:205-213. http://annals.org/article.aspx?articleid=1930861
  9. Platelet transfusion: principles, risks, alternatives and best practice. NCA Platelet Working Group. NHS Blood and Transplant, 2012. http://hospital.blood.co.uk/patient-services/patient-blood-management/platelet-resources/