Do you order apheresis (apheresis) platelets for regular platelet transfusions?

From the Guidelines

For regular platelet transfusions, apheresis platelets are the preferred choice due to their higher quality and reduced risk of alloimmunization and transfusion-transmitted infections. When considering platelet transfusions, it is essential to weigh the risks and benefits, prioritizing morbidity, mortality, and quality of life. According to the AABB guidelines 1, apheresis platelets are recommended for transfusing hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding. The guidelines suggest 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. Some key points to consider when ordering apheresis platelets include:

• A typical adult dose is one apheresis unit, which contains approximately 3-4 × 10^11 platelets
• Specify any special requirements such as irradiation, CMV-negative status, or HLA-matching if the patient has developed platelet refractoriness
• Apheresis platelets reduce the risk of alloimmunization and transfusion-transmitted infections compared to pooled platelets from multiple donors
• They are particularly beneficial for patients requiring long-term platelet support, such as those with hematologic malignancies or bone marrow failure. Platelet transfusions should be given when platelet counts fall below 10,000/μL in stable patients or below 20,000-50,000/μL in patients with additional bleeding risk factors, as suggested by the AABB guidelines 1.

From the Research

Apheresis Platelets for Regular Platelet Transfusions

• Apheresis platelets are used for regular platelet transfusions, as they have several benefits, including reduced donor exposure 2.
• The use of apheresis platelets does not represent an advance in therapeutic efficacy compared to platelets separated from whole blood donations, but it may reduce the risk of alloimmunization 3.
• Apheresis platelets can be considered equivalent to pooled random donor platelet concentrates, with the only specific indication of the former being the care of HLA or HPA allo-immunized patients 4.

Indications and Dose of Apheresis Platelets

• The main indications for platelet transfusions, including apheresis platelets, are well defined and include central thrombocytopenia and other medical and surgical situations 4.
• The optimal platelet dose and transfusion trigger for prophylactic platelet transfusions are being evaluated, with a 10,000/microL prophylactic platelet transfusion trigger documented to be both hemostatically efficacious and cost-effective 5.
• Therapeutic platelet transfusions to control or prevent bleeding with trauma or surgical procedures require higher transfusion triggers, ranging from 50,000/microL to 100,000/microL 5.

Safety and Efficacy of Apheresis Platelets

• Leukoreduction of apheresis platelets can reduce platelet alloimmunization, cytomegalovirus transmission, and febrile transfusion reactions 5, 6.
• Gamma irradiation of apheresis platelets can prevent transfusion-associated graft-versus-host disease 6.
• The expected response to transfused apheresis platelets and reasons for poor responses, including alloimmunization and underlying disease state, are important considerations in platelet transfusion therapy 6.