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Platelet Transfusions
Indications, dose and administration
Indications for platelet transfusions
Dosing recommendations
Decision to transfuse should be based on both laboratory investigations and assessment of the clinical condition
with careful consideration of risks & benefits.
Platelet dose is generally 5 to 10ml/kg.
Usual platelet dose in an adult is 1 adult unit.
Platelet transfusion is not indicated in all cases of thrombocytopenia and may be contraindicated (e.g. immune
thrombocytopenia, thrombotic thrombocytopenia and heparin induced thrombocytopenia).
Platelet Indication
“Don’t use 2 when 1 will do”
Platelet count
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Oncology
Chemotherapy, haemopoetic stem cell transplantation
<10 x 10^9/L
Chemotherapy, haemopoetic stem cell transplantation & risk factors (e.g. fever, minor
bleeding)
<20 x 10^9/L
Lumbar puncture and new disease induced thrombocytopenia
<50 x 10^9/L
Lumbar puncture and on-going chemotherapy induced thrombocytopenia
<30 x 10^9/L
Patient undergoing invasive procedure
<50 x 10^9/L
Patient undergoing high risk invasive procedure (e.g. neuro surgery)
<100 x 10^9/L
Avoid giving excess volume to neonates, infants and small children.
Blood bank will supply the most appropriate unit in stock.
It may be that only a portion of the pack/unit will be administered or multiple pedipaks will be supplied if an
adult unit is not available.
Platelet
product
Weight
<10 kg
10-20 kg
20-30 kg
30-40 kg
>40 kg
Pooled platelets
(adult unit)
5ml/kg to
10ml/kg
5ml/kg to
10ml/kg
5ml/kg to
10ml/kg
1 unit or 10ml/kg
Which ever is less
1 unit
Apheresis platelets
(adult unit)
5ml/kg to
10ml/kg
5ml/kg to
10ml/kg
5ml/kg to
10ml/kg
1 unit or 10ml/kg
Which ever is less
1 unit
Paediatric apheresis
platelets (pedipak)
1 pedipak or
5 - 10 ml/kg
Which ever is
less
2 pedipaks or
5 - 10 ml/kg
Which ever is
less
3 pedipaks or
5 - 10 ml/kg
Which ever is
less
4 pedipaks or
5 - 10 ml/kg
Which ever is less
Invasive procedures
Critically ill patients - limited evidence, suggested thresholds:
Note: higher transfusion triggers may be acceptable in certain circumstances
No bleeding
<10 x 10^9/L
No bleeding & risk factors (e.g. sepsis, renal failure, medications)
<20 x 10^9/L
Extra Corporeal Life Support (lower platelet counts may be acceptable in stable patients)
<100 x 10^9/L
Active bleeding
<50 x 10^9/L
Neonatal thrombocytopenia
<30-50 x 10^9/L
All platelet products are leucocyte depleted and irradiated
Stored at room temperature, never in fridge
Shelf life 5 days
Platelet products, volume and expected platelet increment
Product
Description
Volume
Expected platelet increment
Pooled platelets (adult unit)
Platelets collected from 4 separate donors and pooled into 1 unit
>160 ml. Average 326 ml
1 unit typically increases count by 20 - 40 x 10^9/L in 70 kg adult
Apheresis platelets (adult unit)
Single donor platelets, suspended in donor’s plasma
Can be used to decrease donor exposure in patients frequently transfused.
100–400 ml. Average 180 ml
1 unit typically increases count by 20 - 40 x 10^9/L in 70 kg adult
Paediatric apheresis platelets (pedipak)
Single donor platelets split into 3 to 4 packs (pedipaks) of equal volume
Can be used to reduce donor exposure and minimise product wastage
40–60 ml. Average 51 ml
1 pedipak typically increases count in 18kg child by 20 x 10^9/L
Platelet administration
Use new blood administration filter (170 to 200 micron) when administering platelets.
Use a volumetric pump or syringe driver whenever possible
Do not transfuse platelets via same blood administration filter after red cell transfusion as some platelets may get
caught in fibrin strands/debris caught in filter. (Exception – critical bleeding. Can continue to use same filter
unless flow is impeded by debris caught in filter).
Suggest administer over 1 to 2 hours.
Increased transfusion rates may be associated with increased risk of transfusion reactions.
Must be completed within 4 hours.