Platelet Transfusion Interval in Adolescents with Severe Thrombocytopenia
A standard adult therapeutic dose of platelet concentrate should be infused over 30 minutes, and transfusion should ideally commence within 30 minutes of removal from the platelet storage incubator. 1
Administration Rate and Timing
Infuse each platelet unit over 30 minutes through a standard blood administration set or platelet administration set incorporating a 170- to 200-μm filter. 1
Begin transfusion within 30 minutes of removing the platelet concentrate from the 22°C storage incubator with constant gentle agitation. 1, 2
Never use a blood administration set that has already been used for red cells, and do not add any drugs directly to the platelet unit. 1, 2
Post-Transfusion Monitoring
Check the platelet count 10–60 minutes after transfusion ends to verify adequate response; a 10-minute draw is logistically convenient and yields equivalent results to a 1-hour measurement. 3
An adequate response is defined as a Corrected Count Increment (CCI) ≥ 5,000 or an absolute increment of approximately 3,500/μL per m² of body surface area per unit in children. 3
Dosing for Adolescents
For adolescents, the initial dose is 4–8 platelet concentrates or one apheresis pack, which contains approximately 3–4 × 10¹¹ platelets. 1, 3
Expected platelet increment in children: approximately 3,500/μL per m² of body surface area per unit of platelet concentrate. 3
If the post-transfusion platelet count remains at or below the trigger level that prompted the original transfusion, administer additional platelet units. 3
Target Platelet Counts Based on Clinical Context
For actively bleeding adolescents: maintain platelet count > 75 × 10⁹/L. 1, 2
For severe bleeding, traumatic brain injury, or massive hemorrhage: maintain platelet count > 100 × 10⁹/L. 1, 4, 2
For non-bleeding patients with chemotherapy-induced thrombocytopenia: transfuse only if platelet count < 10 × 10⁹/L. 1
Before invasive procedures: aim for platelet count ≥ 50 × 10⁹/L; for neurosurgical procedures the target is ≥ 100 × 10⁹/L. 4
Storage and Handling Precautions
Platelet concentrates must be stored at 22°C with constant gentle agitation—never place them in a refrigerator, as this damages platelet function. 1, 2
The risk of bacterial infection transmission is 1 in 12,000 due to room-temperature storage, though bacterial screening before release reduces this risk. 1, 2
Common Pitfalls to Avoid
Do not proceed with invasive procedures without laboratory confirmation that a hemostatic platelet count has been achieved. 3
Ensure ABO compatibility when possible; ABO-incompatible platelets yield reduced post-transfusion increments. 3, 4
Do not diagnose platelet refractoriness after a single poor increment—require at least two consecutive inadequate responses with ABO-compatible units stored < 72 hours. 3
Controlled infusion over 30 minutes allows better monitoring for adverse reactions, including transfusion-related acute lung injury (TRALI) and circulatory overload. 2