Platelet Infusion Rate
Platelet transfusions should be administered over 30-60 minutes for a standard adult dose, with infusion started within 30 minutes of removal from storage at 22°C. 1
Standard Infusion Protocol
- Infuse platelets over 30 minutes as the standard rate for an adult therapeutic dose (250-350 mL containing ≥2.4 × 10¹¹ platelets). 2
- The acceptable range is 30-60 minutes for completion of a standard adult dose. 1
- Maximum allowable time is 4 hours from start of infusion, though this extended duration should be avoided when possible. 1
- Infusion must begin within 30 minutes of removing platelets from temperature-controlled storage (20-24°C). 1
Equipment Requirements
- Always use a standard blood administration set with a 170-200 μm filter. 2, 1
- Do not use a giving set that has previously been used for red cell transfusion, as residual red cells may cause transfused platelets to stick and reduce the effective dose. 2
- A special platelet giving set is ideal but unnecessary in massive hemorrhage situations—the critical issue is using a clean 170-200 μm filter set. 2
Rapid Infusion in Massive Hemorrhage
- In massive hemorrhage, rapid infusion devices capable of 6-30 L/h may be used when large volumes must be infused quickly. 2
- External pressure devices can administer platelets within a few minutes when used with large-gauge venous access in emergency situations. 2
- Higher infusion rates of platelets (mean 3.5 mL/min in survivors vs 1.1 mL/min in non-survivors) during the first 180 minutes of trauma resuscitation are associated with improved survival. 3
Critical Timing Considerations
- Total time outside temperature-controlled environment should be restricted to 30 minutes. 1
- Platelets are stored at 22°C with constant gentle agitation and must not be refrigerated. 2
- The 30-minute infusion time balances the need for rapid administration with the risk of transfusion-associated circulatory overload (TACO), which occurs at a rate of 1:167 platelet units when actively surveilled. 4
Post-Transfusion Monitoring
- Obtain a platelet count 10-60 minutes after transfusion completion to assess response before any planned invasive procedures. 1, 2
- A standard adult dose should increase the platelet count by approximately 30,000-50,000/μL. 2, 1
- Do not assume adequate platelet levels without laboratory confirmation. 1
Common Pitfalls to Avoid
- Avoid slow infusion rates that extend beyond 4 hours, as this increases bacterial contamination risk (1 in 12,000 baseline risk due to 22°C storage). 2
- Do not delay infusion start beyond 30 minutes of removal from storage, as platelet viability decreases. 1
- In bleeding patients or those requiring procedures, faster infusion (30 minutes) is preferred over slower rates to achieve hemostatic targets more rapidly. 2, 3