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PVT

8.4                                        PLATELETS

 

 

In WA there are two platelet products that are released from the ARCBS.

 

Single Donor Apheresed Leucodepleted Platelets

 

This is a single dose of platelets from one donor collected via an aphaeresis machine with platelets suspended in donor plasma.

Leucodepletion has occurred at time of collection.

This will be the more common of the two products in circulation

Vol 100-400 mL

 

Pooled Leucodepleted Platelets

 

This is an adult dose of platelets obtained from a pool of buffy coats from ABO identical donors. (4 random donors)

Leucodepletion has occurred at time of pooling.

Vol: > 160ml

 

 

Platelets are indicated for the prevention & treatment of haemorrhage in patients with thrombocytopenia or platelet dysfunction.

Use should be confined to patients with thrombocytopenia and/or functional abnormalities who have significant bleeding from this cause.

 

Prophylaxis

 

·         Bone marrow failure: Platelet count <10x10^9/L in the absence of risk factors or <20x10^9/L in the presence of risk factors eg: fever, antibiotics

 

·         Surgery/invasive procedures: General maintain platelet count at >50x10^9/L. For surgical procedures with high risk of bleeding (ocular or neurosurgery) count >100x10^9/L

 

·         Platelet function disorders: May be appropriate in acquired or inherited disorders.

 

Treatment

 

·         Bleeding: May be appropriate in any patient in whom thrombocytopenia is considered a major contributory factor.

 

·         Massive haemorrhage/transfusion: May be appropriate when platelet count < 50x10^9/L in presence of diffuse microvascular bleeding. Higher count of 100x10^9/L recommended with multiple trauma or central nervous system injury.

 

 

 

 

 

OUTCOME

 

To ensure the safe and effective transfusion of platelets, in the appropriate amount at the appropriate time where the benefits of the transfusion out weigh the potential risks.

 

Protocol

 

2.0 Requesting Blood Products

3.0 Sample collection – Crossmatching

 

 

Platelets are ordered from Red Cross Blood Service via your local transfusion service provider as required. They are not stored on-site

 

·         ABO group needs to be known – 1 x EDTA sample (Correct labeling criteria applies to both sample and request form)

 

·         Platelet count needs to be known – 1 x EDTA sample (As above)

 

Platelets need to be ordered by the treating physician by way of request form.

In case of emergency a telephone request is adequate initially – followed by written request.

 

Contact transfusion service provider – they will complete designated fresh product request form and liaise with the ARCBS on availability.

This will then be communicated to hospital/treating clinician.

 

Platelets MUST be stored at room temperature (20-24 degrees) on a platelet rocker/ or with gentle agitation until administered.

                 

                      DO NOT refrigerate or leave lying on a bench

 

PERSONNEL ABLE TO PERFOM

 

Medical Officers

Registered Nurse + another RN or EN

 

 

 

EQUIPMENT                     IV Therapy Chart (ordered for number of units, rate)

                                      Blood component

                                      Observations chart

                                        Standard blood administration set

                                      IV giving set

                                        Leucocyte depletion filter (if required)

 

 

PRETRANSFUSION

 

 

 

Refer: Blood products summary & indications

          Summary of Transfusion Guidelines (NHMRC/ASBT 2002) 

               Consent 1.0

Ensure integrity of vein with IV in situ before retrieving component from approved storage Collection of blood products 4.2

 

 

Ensure IV line (approved for blood administration) is primed with normal saline

 

Perform integrity check of component – 6.2

 

Perform vital bedside identity check – 6.0

 

Any discrepancy - STOP – contact the transfusion service provider immediately

 

 

 

ADMINISTRATION

 

Platelets of the patient’s ABO should be given if available.

 

Occasionally blood of identical ABO may not be available; an alternative group shall be selected by your transfusion service provider after consultation with a Haematologist.

 

·         Transfuse immediately upon receipt – over 30 minutes, unless otherwise clinically indicated

·         Transfuse via standard blood administration set (where following a red cell transfusion a new giving set MUST be used)

·         First 15 minutes rate no more than 5mls/min, unless otherwise clinically indicated

·         Flush with saline at end of transfusion EXCEPT when using leucocyte depletion filters (follow manufacturers instructions)

·         Never transfuse platelets through a used giving set post red cell transfusion.

 

Where a pre-menopausal female who is Rh negative receives Rh positive platelets then prophylactic anti-D should be considered.

 

 

OBSERVATIONS

 

·         The nurse WILL stay with the patient  throughout the platelet transfusion

·         Record pretransfusion (baseline) TPR and BP at commencement of each component

·         T, P,R & BP at 15 minutes then on completion

·         Check cannula site with observations

 

Stop Transfusion and notify Doctor Immediately of any Transfusion Reactions

 

·         Post transfusion platelet counts can be helpful in monitoring the increment to platelets (10min – 1 hour after transfusion)

·         Patients’ refractory to platelets (due to multiple transfusions) may require HLA typed or cross-matched platelets.  Discussion with a Haematologist is required

 

ADVERSE REACTIONS

 

·         Reactions to platelets are usually febrile or allergic. 

·         Hydrocortisone, antihistamine and rarely adrenaline are required

 

SPECIAL MODIFICATIONS

9.2 Irradiated

9.3 CMV negative