Platelet transfusion

Platelet transfusion

A bag of platelets
Clinical data
Other names	Platelet concentrate, platelet component
ATC code	B05A (WHO)
Identifiers
ChemSpider	none

Platelet transfusion, also known as platelet concentrate, is used to prevent or treat

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][12][13]} If the person is well using a higher platelet count threshold does not reduce the risk of bleeding further.^[14]

Prevention versus treatment of bleeding

A review in people with blood cancers receiving intensive chemotherapy or a stem cell transplant 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.^[15] However, this benefit was only seen in certain patient groups, and people undergoing an autologous stem cell transplant derived no obvious benefit.^[15] Despite prophylactic platelet transfusions, people with blood cancers often bleed, and other risk factors for bleeding such as inflammation and duration of thrombocytopenia should be considered.^[13]

There is little evidence for the use of preventive platelet transfusions in people with chronic bone marrow failure, such as myelodysplasia or aplastic anemia.^[16] Multiple guidelines recommend prophylactic platelet transfusions are not used routinely in people with chronic bone marrow failure, and instead an individualised approach should be taken.^[11][10][13]

Several studies have now assessed the benefit of using preventive platelet transfusions in adults with dengue who have profound thrombocytopenia (platelet count < 20 x 10⁹/L.^[17] There is no evidence that this reduce the risk of bleeding, but there is evidence that they increase the risk of harm due to the platelet transfusion (increased risk of a transfusion reaction including anaphylaxis).^[17]

Platelet transfusion threshold

Two reviews in people with blood cancers receiving intensive chemotherapy or a stem cell transplant found that overall giving platelet transfusions when the platelet count is less than 10 x 10⁹/L compared to giving platelet transfusions when the platelet count is less than 20 or 30 x 10⁹/L had no effect on the risk of bleeding.^[14][18]

Higher platelet transfusion thresholds have been used in premature neonates, but this has been based on limited evidence.^[19] There is now evidence that using a high platelet count threshold (50 x 10⁹/L) increases the risk of death or bleeding compared to a lower platelet count threshold (25 x 10⁹/L) in premature neonates.^[20]

Dose

A review in people with

In people with a low platelet count, prophylactic platelet transfusions do not need to be given prior to procedures that have a low risk of causing bleeding.[10]^[13][9] Low-risk procedures include surgical sites that do not contain many blood vessels e.g. cataract surgery,^[13] or minor procedures.^[10][13] The evidence is very uncertain about the effect of platelet transfusions prior to surgery for people with a low platelet count on the all-cause mortality, the number of participants with bleeding events after surgery, serious surgery-related or transfusion-related adverse events.^[23]

Guidelines recommend that it is safe to perform central venous catheter insertion when the platelet count is 20 x 10⁹/L or above.^[9][13] The evidence for this is based on observational studies in which bleeding occurred due to procedure error rather than due to the platelet count.^[13][24]

Platelet transfusion thresholds for more major procedures are based on expert opinion alone.^[25] Guidelines recommend a threshold of 50 x 10⁹/L for major surgery and a threshold of 100 x 10⁹/L for surgery on the brain or the back of the eye.^[10][13][11]

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]

Side effects

Side effects can include

Platelet transfusions came into medical use in the 1950s and 1960s.[1] It is on the World Health Organization's List of Essential Medicines.^[6]

Society and culture

In the United Kingdom it costs the NHS about 200 pounds per unit.^[31]

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