How to Order Platelet Concentrate in the Chart
Order one standard adult therapeutic dose (single apheresis unit or pool of 4-6 whole blood-derived platelet concentrates containing 3-4 × 10¹¹ platelets) to be infused over 30 minutes through a dedicated platelet administration set with appropriate filter. 1, 2
Essential Order Components
Product Specification
- Standard adult dose: One apheresis platelet unit OR pooled platelet concentrate (4-6 units) 1
- Pediatric dosing: 5-10 mL/kg for infants <15 kg; 3 × 10¹¹ platelets for children 30-120 pounds; 6 × 10¹¹ platelets for patients >120 pounds 3
- Each unit contains 250-350 mL with platelet count >2.4 × 10¹⁰/L 1
Blood Type Matching Requirements
- ABO compatibility: Platelets do not require exact ABO matching, but group O platelets given to non-group O children should be high-titre negative 1
- Rh matching: D-negative children and women of childbearing potential must receive D-negative platelets to prevent anti-D alloimmunization 1
Administration Instructions to Include in Order
- Infusion rate: Administer over 30 minutes 1, 2
- Equipment: Use dedicated platelet administration set with 170-200 μm filter 1
- Critical: Do NOT use tubing previously used for red cells 1, 2
- Storage: Commence transfusion within 30 minutes of removal from 22°C platelet incubator 1, 2
- Never refrigerate: Platelets must never be placed in refrigerator 1, 2
Clinical Thresholds for Ordering
Prophylactic Transfusion (Non-Bleeding Patients)
- Chemotherapy-induced thrombocytopenia: Order when platelet count ≤10 × 10⁹/L 1
- Pre-procedure thresholds: 1
- Central venous catheter insertion: >20 × 10⁹/L
- Major surgery: >50 × 10⁹/L
- Neurosurgery/CNS procedures: 80-100 × 10⁹/L
Therapeutic Transfusion (Active Bleeding)
- General bleeding: Target platelet count >75 × 10⁹/L 1, 4
- Severe bleeding or traumatic brain injury: Target >100 × 10⁹/L 4
- Massive hemorrhage with microvascular bleeding: Maintain >75 × 10⁹/L 1
Massive Transfusion Protocol
- Order platelets when platelet count falls below 50 × 10⁹/L during massive hemorrhage 1
- Target minimum 75 × 10⁹/L in actively bleeding patients 1
- Consider early platelet transfusion to prevent dilutional coagulopathy 1
Post-Transfusion Monitoring Orders
Laboratory Follow-Up
- Immediate: Order CBC with platelet count 1 hour post-transfusion to assess response 1
- Expected increment: Platelet count should increase by approximately 30 × 10⁹/L per standard adult dose 1, 3
- Refractoriness evaluation: If inadequate response, order HLA antibody testing 5
Documentation Requirements
- Document pre-transfusion platelet count 1
- Record clinical indication (prophylactic vs. therapeutic) 1
- Note any active bleeding or planned procedures 1
Critical Pitfalls to Avoid
Common Ordering Errors
- Never add medications directly to platelet unit 1, 2
- Do not order platelets solely based on count without clinical context - bleeding risk depends on multiple factors beyond platelet number 6
- Avoid refrigeration - this permanently damages platelet function 1, 2
- Do not use expired tubing from red cell transfusions 1, 2
Special Clinical Scenarios
Patients on antiplatelet therapy with intracranial hemorrhage: Evidence is highly uncertain and conflicting regarding benefit of platelet transfusion 4. Consider clinical bleeding severity and neurosurgical consultation rather than routine transfusion.
Consumptive coagulopathy: Platelet transfusion alone may be insufficient - order concurrent FFP or cryoprecipitate if fibrinogen <1.0 g/L 1, 4
Bacterial contamination risk: Platelets carry highest bacterial transmission risk (1 in 12,000) due to 22°C storage 1. Monitor for fever and sepsis during infusion 1
Sample Order Format
"Transfuse 1 unit apheresis platelets (or 1 pooled platelet concentrate) IV over 30 minutes via dedicated platelet administration set with 170-200 μm filter. ABO-compatible, Rh-negative [if applicable]. Do not refrigerate. Commence within 30 minutes of removal from platelet incubator. Obtain CBC with platelet count 1 hour post-transfusion." 1, 2