What is the recommended volume of platelets (platelet transfusion) to transfuse in milliliters (mL)?

Platelet Transfusion Volume

The standard volume for platelet transfusion is approximately 200-350 mL per adult therapeutic dose, which corresponds to one apheresis unit or a pool of 4-6 whole blood-derived platelet concentrates. 1

Standard Product Volumes and Specifications

Apheresis Platelets (Single-Donor)

• Volume: Approximately 200 mL per unit 1
• Contains at least 3 × 10¹¹ platelets (FDA standard) 1
• Larger products may reach 250-350 mL if the donor center collected a higher dose 1
• Each unit should increase platelet count by >30 × 10⁹/L in an average adult 1, 2

Pooled Whole Blood-Derived Platelets

• Volume: 250-350 mL per pooled adult dose 1
• Consists of 4-6 individual platelet concentrates pooled together 1, 2
• Each individual concentrate contains approximately 7.5 × 10¹⁰ platelets 2
• Total platelet content: >2.4 × 10¹¹ per adult dose 1

Dosing by Clinical Context

Prophylactic Transfusion (Non-Bleeding Patients)

• Standard dose: One apheresis unit (200 mL) or 4-6 pooled concentrates (250-350 mL) 1, 2
• Low-dose option: Half the standard dose (~1.5-2 × 10¹¹ platelets) is equally effective but requires more frequent transfusions 1, 2
• Higher doses (double standard) provide no additional bleeding protection and waste resources 1, 2

Therapeutic Transfusion (Active Bleeding)

• Initial dose: 4-8 platelet concentrates or one apheresis pack 2
• Volume will be 200-350 mL depending on product type 1
• Target platelet count >50 × 10⁹/L for general bleeding 2, 3
• Target >100 × 10⁹/L for traumatic brain injury or massive hemorrhage 2, 3

Pediatric Considerations

For children requiring volume reduction (severe volume restriction or ABO-incompatible platelets for neonates):

• Plasma can be removed from the platelet product before transfusion 1
• Warning: 15-55% of platelets are lost during volume reduction 1
• Volume reduction should be limited to situations where absolutely necessary 1
• For infants <15 kg: dose is 5-10 mL/kg of platelet concentrate 4

Critical Pitfalls to Avoid

• Do not assume all apheresis units are the same volume: Many centers split apheresis collections into 2-3 products, reducing the dose to equivalent of 4-5 whole blood units rather than 6-9 units 1
• Check your local blood supplier's policies to determine actual platelet content and volume per unit 1
• Never refrigerate platelets: They must be stored at 20-24°C with continuous agitation 1
• Transfuse within 30 minutes of removal from the platelet incubator 1
• Use appropriate administration sets: Standard blood administration set or platelet-specific set with 170-200 μm filter; never use a set previously used for red cells 1
• Infusion time: 30 minutes for standard adult dose 1

Post-Transfusion Monitoring

• Obtain platelet count 10-60 minutes post-transfusion to assess response 1
• Expected increment: 2,000/μL per unit of whole blood-derived platelets or 10,000/μL per apheresis unit 1
• Corrected count increment (CCI) ≥5,000 indicates adequate response 1
• If two consecutive ABO-compatible transfusions (stored <72 hours) yield poor increments, investigate for refractoriness 1