From the Guidelines
Platelets should be transfused at a rate of 10-20 mL per minute, or as tolerated by the patient, with a standard dose of up to a single apheresis unit or equivalent, as recommended by the AABB guideline from 2015 1. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding, with a strong recommendation based on moderate-quality evidence 1. Key considerations for platelet transfusion include:
- Transfusing up to a single apheresis unit or equivalent, as greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective 1
- Monitoring vital signs before, during, and after the transfusion to watch for signs of transfusion reactions such as fever, chills, hives, or difficulty breathing
- Using a standard blood administration set (170-260 micron filter) for platelet transfusions, and avoiding leukocyte reduction filters, as these can remove platelets For patients with specific conditions, such as heart or kidney problems, or those at risk of volume overload, a slower infusion rate may be necessary, and consultation with the treating physician is recommended. The relatively rapid infusion rate for platelets is possible because they have a smaller volume compared to red blood cells and don't significantly increase blood volume, allowing for quick administration to ensure that the maximum number of transfused platelets remain in circulation to improve hemostasis.
From the Research
Platelet Transfusion Rates
The appropriate rate for transfusing platelets depends on various factors, including the patient's condition, platelet count, and the presence of bleeding or risk of bleeding.
- According to 2, the post-transfusion blood platelet count will be approximately 20 x 10(9)/L following transfusion of 3 x 10(11) platelets to a 5 foot, 8 inch patient weighing 170 pounds (2.0 m2), who is bleeding because of a pre-transfusion platelet count of 5 x 10(9)/L.
- The study 2 also suggests that adjusting dose for body size, bleeding patients with pre-transfusion blood platelet of < 10 x 10(9)/L and weighing > 120 pounds should receive approximately 6 x 10(11) platelets, those weighing 30 to 120 pounds should receive 3 x 10(11) platelets, and infants weighing < 30 pounds (15 kg) should receive 5-10 ml/kg of platelet concentrate.
- Another study 3 found that the platelet dose was approximately 3 to 4 x 10(11) per L transfusion, with a median platelet increase of 14 x 10(9) per L (IQR, -2 to 30) measured at 5.2 hours (IQR, 1.8 to 8.8) after the transfusion.
Indications for Platelet Transfusion
Platelet transfusion is indicated in certain situations, including:
- Active hemorrhage or platelet counts less than 10 × 10(3) per μL, as stated in 4.
- Prophylactic platelet transfusion in stable oncohematology recipients with a platelet count of less than 10 × 10(9) per L, as recommended in 5.
- Patients undergoing surgical procedures, with higher trigger values for platelet transfusion, as suggested in 5.
Clinical Considerations
When considering platelet transfusion, it is essential to evaluate the patient's individual needs and circumstances.
- The study 6 found that early platelet transfusion guided by protocol-based clinical judgment and rapid-turnaround platelet counts was not associated with increased mortality in massively transfused trauma patients.
- The decision to transfuse platelets should be based on a careful assessment of the patient's condition, including their platelet count, presence of bleeding or risk of bleeding, and other relevant factors, as emphasized in 5 and 3.