Platelet transfusion

Platelet transfusion
A bag of platelets
Clinical data
Synonyms Platelet concentrate, platelet component
ATC code
Identifiers
ChemSpider
  • none

Platelet transfusion, also known as platelet concentrate, is used to prevent or treat bleeding in people with either a low platelet count or poor platelet function.[1] Often this occurs in people receiving cancer chemotherapy.[1] Preventative transfusion is often done in those with platelet levels of less than 10 x 109/L.[2] In those who are bleeding transfusion is typically carried out at less than 50 x 109/L.[2] Blood group matching (ABO, RhD) is typically recommended before platelets are given.[2] Unmatched platelets, however, are often used due to the unavailability of matched platelets.[3] They are given by injection into a vein.[4]

Side effects can include allergic reactions such as anaphylaxis, infection, and lung injury.[2] Bacterial infections are relatively more common with platelets as they are stored at warmer temperatures.[2] Platelets can be produced either from whole blood or by apheresis.[1] They keep for up to five to seven days.[1]

Platelet transfusions came into medical use in the 1950s and 1960s.[1][5] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6] In the United Kingdom it costs the NHS about 200 pounds per unit.[7] Some versions of platelets have had the white blood cells partially removed or been gamma irradiated which have specific benefits for certain populations.[8]

Medication use

Prevention of bleeding

International guidelines recommend that platelets transfusions are given to people with reversible bone marrow failure to reduce the risk of spontaneous bleeding when the platelet count is less than 10 x 109/L.[9][10][11]

Dose

A review in people with blood cancers compared different platelet transfusion doses.[12] This review found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets (low dose – 1.1 x 1011/m2) and those that contained an intermediate number of platelets (intermediate dose – 2.2 x 1011/m2). This review also found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets and those that contained a large number of platelets (high dose – 4.4 x 1011/m2).[12] One of the review's included studies reported on transfusion reactions. This study’s authors suggested that a high-dose platelet transfusion strategy may lead to a higher rate of transfusion-related adverse events.[13]

Treatment of bleeding

There is little evidence for the effectiveness of platelet transfusions or the optimal dose when a person with a low platelet count is actively bleeding. Current recommendations are based on consensus guidelines from around the world.[10][9]

Prevention versus treatment

A review in people with haematological malignancies found that overall giving platelet transfusions when the platelet count is less than 10 x 109/L reduced the number of bleeding events and days with significant bleeding.[14] However, this benefit was only seen in certain patient groups, and people undergoing an autologous stem cell transplant derived no obvious benefit.[14]

Side effects

Side effects can include allergic reactions such as anaphylaxis, infection, and lung injury.[2] Bacterial infections are relatively more common with platelets as they are stored at warmer temperatures.[2]

Usage

People with hematological disorders or cancer receive the largest proportion of platelet transfusions.[15][16][17] Most are given to prevent bleeding during treatment with chemotherapy or stem cell transplant.[17][16][18] Much of the remainder are used in general medicine, cardiac surgery and in intensive care.[17][16][18]

Unlike other blood products demand for platelet transfusions appears to be increasing in several countries around the world.[15] An ageing population, an increase in the number of people with blood cancer, and changes to the management of these cancers are likely the major reasons for the rise in demand for platelets.[15] Since 1990, the number of stem cell transplants performed in Europe has risen from 4,200 to over 30,000 annually.[19]

History

Platelet transfusions came into medical use in the 1950s and 1960s.[1] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[6]

Society and culture

In the United Kingdom it costs the NHS about 200 pounds per unit.[7]

Manufacture

Platelets can be produced either from whole blood donations or by apheresis.[1] They keep for up to five to seven days.[1]

Platelet components can have had the white blood cells partially removed (leucodepleted) which decreases the risk of having a transfusion reaction.[20] They can be treated with ultraviolet light which decreases the risk of transmission of certain infections.[21] They can be gamma irradiated which have specific benefits for certain populations (those at risk of transfusion-associated graft versus host disease).[8]

References

  1. 1 2 3 4 5 6 7 8 Hillyer, Christopher D. (2007). Blood Banking and Transfusion Medicine: Basic Principles & Practice. Elsevier Health Sciences. pp. 308–310. ISBN 0443069816. Archived from the original on 2017-01-12.
  2. 1 2 3 4 5 6 7 Connell, NT (December 2016). "Transfusion Medicine". Primary care. 43 (4): 651–59. doi:10.1016/j.pop.2016.07.004. PMID 27866583.
  3. ↑ Josephson, Cassandra D.; Castillejo, Marta-Inés; Grima, Kathleen; Hillyer, Christopher D. (2010-02-01). "ABO-mismatched platelet transfusions: Strategies to mitigate patient exposure to naturally occurring hemolytic antibodies". Transfusion and Apheresis Science. 42 (1): 83–88. doi:10.1016/j.transci.2009.10.013. ISSN 1473-0502. PMID 20034854.
  4. ↑ Linton, Adrianne Dill (2015). Introduction to Medical-Surgical Nursing. Elsevier Health Sciences. p. 287. ISBN 9781455776412. Archived from the original on 2017-01-12.
  5. ↑ Das, P. C.; Smit-Sibinga, C. T. h; Halie, M. R. (2012). Supportive therapy in haematology. Springer Science & Business Media. p. 190. ISBN 9781461325772. Archived from the original on 2017-01-10.
  6. 1 2 "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Archived (PDF) from the original on 13 December 2016. Retrieved 8 December 2016.
  7. 1 2 Yentis, Steven M.; Hirsch, Nicholas P.; Ip, James (2013). Anaesthesia and Intensive Care A–Z: An Encyclopedia of Principles and Practice. Elsevier Health Sciences. p. 147. ISBN 9780702053757. Archived from the original on 2017-01-12.
  8. 1 2 Hillyer, Christopher D. (2007). Blood Banking and Transfusion Medicine: Basic Principles & Practice. Elsevier Health Sciences. p. 320. ISBN 0443069816. Archived from the original on 2017-01-12.
  9. 1 2 Kaufman, Richard M.; Djulbegovic, Benjamin; Gernsheimer, Terry; Kleinman, Steven; Tinmouth, Alan T.; Capocelli, Kelley E.; Cipolle, Mark D.; Cohn, Claudia S.; Fung, Mark K. (2015-02-03). "Platelet Transfusion: A Clinical Practice Guideline From the AABB". Annals of Internal Medicine. 162 (3): 205–13. doi:10.7326/M14-1589. ISSN 0003-4819. PMID 25383671.
  10. 1 2 "Blood transfusion | Guidance and guidelines | NICE". www.nice.org.uk. Archived from the original on 2016-01-16. Retrieved 2016-01-21.
  11. ↑ "Patient Blood Management Guidelines | National Blood Authority". www.blood.gov.au. Archived from the original on 2016-01-15. Retrieved 2016-01-21.
  12. 1 2 Estcourt, Lise J.; Stanworth, Simon; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Blanco, Patricia; Murphy, Michael F. (2015-01-01). "Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 10: CD010984. doi:10.1002/14651858.CD010984.pub2. ISSN 1469-493X. PMC 4724938. PMID 26505729.
  13. ↑ Kaufman, Richard M.; Assmann, Susan F.; Triulzi, Darrell J.; Strauss, Ronald G.; Ness, Paul; Granger, Suzanne; Slichter, Sherrill J. (2015-01-01). "Transfusion-related adverse events in the Platelet Dose study". Transfusion. 55 (1): 144–53. doi:10.1111/trf.12791. ISSN 1537-2995. PMC 4293226. PMID 25065959.
  14. 1 2 Crighton, Gemma L.; Estcourt, Lise J.; Wood, Erica M.; Trivella, Marialena; Doree, Carolyn; Stanworth, Simon (2015-01-01). "A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 9: CD010981. doi:10.1002/14651858.CD010981.pub2. ISSN 1469-493X. PMC 4610062. PMID 26422767.
  15. 1 2 3 Estcourt, L. J. (2014-10-01). "Why has demand for platelet components increased? A review". Transfusion Medicine (Oxford, England). 24 (5): 260–68. doi:10.1111/tme.12155. ISSN 1365-3148. PMID 25327286.
  16. 1 2 3 Charlton, A.; Wallis, J.; Robertson, J.; Watson, D.; Iqbal, A.; Tinegate, H. (2014-08-01). "Where did platelets go in 2012? A survey of platelet transfusion practice in the North of England". Transfusion Medicine (Oxford, England). 24 (4): 213–18. doi:10.1111/tme.12126. ISSN 1365-3148. PMID 24957661.
  17. 1 2 3 Cameron, Bruce; Rock, Gail; Olberg, Bernard; Neurath, Doris (2007-02-01). "Evaluation of platelet transfusion triggers in a tertiary-care hospital". Transfusion. 47 (2): 206–11. doi:10.1111/j.1537-2995.2007.01090.x. ISSN 0041-1132. PMID 17302765.
  18. 1 2 Whitaker, Barbee I; Rajbhandary, Srijana; Harris, Angela (2015). The 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey Report. AABB. Archived from the original on 2016-01-26.
  19. ↑ Passweg, J. R.; Baldomero, H.; Gratwohl, A.; Bregni, M.; Cesaro, S.; Dreger, P.; de Witte, T.; Farge-Bancel, D.; Gaspar, B. (2012-07-01). "The EBMT activity survey: 1990–2010". Bone Marrow Transplantation. 47 (7): 906–23. doi:10.1038/bmt.2012.66. ISSN 1476-5365. PMID 22543746.
  20. ↑ "FAQ: Leucodepletion of red cells and platelets". transfusion.com.au. 14 December 2015. Archived from the original on 13 July 2017. Retrieved 18 July 2017.
  21. ↑ Butler, Caroline; Doree, Carolyn; Estcourt, Lise J; Trivella, Marialena; Hopewell, Sally; Brunskill, Susan J; Stanworth, Simon; Murphy, Michael F (2013-03-28). Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd. doi:10.1002/14651858.cd009072.pub2. ISSN 1465-1858. Archived from the original on 2014-04-18.
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