Platelet Concentrates

How to Cite This Chapter: Morin P-A, Ning S, Łętowska M, Rosiek A. Platelet Concentrates. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.15.62.2. Accessed November 30, 2021.
Last Updated: February 19, 2020
Last Reviewed: January 22, 2021
Chapter Information

Platelet concentrates in Canada are either pooled (produced by combining platelets from >1 blood donor collected from whole blood) or apheresis platelets (collected from a single blood donor using apheresis techniques). Regardless of the method of production, 1 adult dose of platelet concentrate contains ~300 × 109 platelets in 280 mL of plasma, with minimal leukocyte content. Platelet concentrate may be stored for up to 7 days at 20 to 24 degrees Celsius in containers with constant agitation. Transfusion of 1 adult dose of platelets should increase the platelet count by ≥15 to 25 × 109/L at 1 hour post transfusion.

Special platelet products: Table 8.10-1.

IndicationsTop

1. In patients with platelet counts <10 × 109/L, prophylactic platelet transfusions are appropriate in case of nonimmune thrombocytopenia (if the patient has immune thrombocytopenia [ITP], heparin-induced thrombocytopenia [HIT], or thrombotic thrombocytopenic purpura [TTP], transfuse only if there is life-threatening bleeding).

2. In patients with platelet counts <20 × 109/L, prophylactic platelet transfusions are appropriate prior to procedures not associated with significant blood loss (eg, central line insertion).

3. In patients with platelet counts <50 × 109/L, prophylactic platelet transfusions are appropriate prior to major surgical procedures not involving the central nervous system and prior to diagnostic lumbar punctures.

4. In patients with platelet counts <100 × 109/L, prophylactic platelet transfusions are appropriate prior to neurosurgical procedures.

5. For patients with significant clinical bleeding, a platelet target ≥50 × 109/L should be considered.

6. For any platelet count, transfusion is appropriate if there is platelet dysfunction (eg, antiplatelet agent use, cardiac surgery) and significant bleeding. In patients receiving antiplatelet therapy with intracranial hemorrhage and platelet counts >100 × 109/L, platelet transfusions may be associated with worse clinical outcomes.

ProcedureTop

In stable adult patients transfuse slowly (50 mL/h) for the first 15 minutes of an adult dose of platelets. In Canada, platelets cannot be ordered as individual units but rather only as doses (1 adult dose of platelets contains 4 units). Each adult dose of platelets is typically infused over 1 hour, with a maximum duration of 4 hours. ABO/Rh nonidentical platelets may be transfused when ABO/Rh identical platelets are not available. Women of current or future childbearing potential who are RhD negative should receive Rh immunoglobulin either prior to or within 72 hours after receiving an RhD-positive platelet concentrate transfusion.

TablesTop

Table 8.10-1. Special platelet products

HLA-matched platelets

Poor response to platelet transfusion (platelet refractoriness) may occur in patients with antibodies to the HLA system. In such patients HLA-matched platelets may be of benefit to improve posttransfusion count increments.

HPA-matched platelets

 

Poor response to platelet transfusion (platelet refractoriness) may occur in patients with antibodies to the HPA system. In such patients HPA-matched platelets may be of benefit to improve posttransfusion count increments.

HPA-matched platelets may also be required in cases of posttransfusion purpura or neonatal alloimmune thrombocytopenia.

Washed platelets

May be considered in patients with confirmed IgA deficiency and anti-IgA antibodies in the presence of a history of severe allergic reactions. Washed platelets may also be indicated in patients who require platelet transfusions but have repeated allergic reactions unresponsive to other measures (eg, premedication).

Washed platelet concentrate contains platelets separated from plasma and suspended in solution.

Irradiated platelets

See Irradiation of Blood Products

HLA, human leukocyte antigen; HPA, human platelet antigen.

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