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. Often this occurs in people receiving cancer chemotherapy. Preventative transfusion is often done in those with platelet levels of less than 10 x 109/L. In those who are bleeding transfusion is typically carried out at less than 50 x 109/L. Blood group matching (ABO, RhD) is typically recommended before platelets are given. Unmatched platelets, however, are often used due to the unavailability of matched platelets. They are given by injection into a vein.
Side effects can include allergic reactions such as anaphylaxis, infection, and lung injury. Bacterial infections are relatively more common with platelets as they are stored at warmer temperatures. Platelets can be produced either from whole blood or by apheresis. They keep for up to five to seven days.
Platelet transfusions came into medical use in the 1950s and 1960s. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. In the United Kingdom it costs the NHS about 200 pounds per unit. Some versions of platelets have had the white blood cells partially removed or been gamma irradiated which have specific benefits for certain populations.
Video Platelet transfusion
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.
Dose
A review in people with blood cancers compared different platelet transfusion doses. 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). 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.
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.
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. However, this benefit was only seen in certain patient groups, and people undergoing an autologous stem cell transplant derived no obvious benefit.
Maps Platelet transfusion
Side effects
Side effects can include allergic reactions such as anaphylaxis, infection, and lung injury. Bacterial infections are relatively more common with platelets as they are stored at warmer temperatures.
Usage
People with hematological disorders or cancer receive the largest proportion of platelet transfusions. Most are given to prevent bleeding during treatment with chemotherapy or stem cell transplant. Much of the remainder are used in general medicine, cardiac surgery and in intensive care.
Unlike other blood products demand for platelet transfusions appears to be increasing in several countries around the world. 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. Since 1990, the number of stem cell transplants performed in Europe has risen from 4,200 to over 30,000 annually.
History
Platelet transfusions came into medical use in the 1950s and 1960s. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.
Society and culture
In the United Kingdom it costs the NHS about 200 pounds per unit.
Manufacture
Platelets can be produced either from whole blood donations or by apheresis. They keep for up to five to seven days.
Platelet components can have had the white blood cells partially removed (leucodepleted) which decreases the risk of having a transfusion reaction. They can be treated with ultraviolet light which decreases the risk of transmission of certain infections. They can be gamma irradiated which have specific benefits for certain populations (those at risk of transfusion-associated graft versus host disease).
References
External links
- Platelet Transfusion: A Clinical Practice Guideline From the AABB Guideline from the American Association of Blood Banks published 2015.
- Australian Patient Blood Management Guidelines.
- Handbook of Transfusion Medicine Free book published in the UK 5th edition.
Source of the article : Wikipedia