Platelet Concentrates

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). In 2022, the Canadian Blood Services started the implementation of pathogen-reduced platelets, which will largely replace the non–pathogen reduced inventory. Pathogen inactivation technology reduces the risk of transfusion-transmitted pathogens. One adult dose of platelet concentrate contains 250×109 platelets.

Special platelet products: Table 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. 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.

The platelet count increment and frequency of complications of pooled and apheresis platelets are comparable.

TablesTop