If ABO compatible components are unavailable, patient age, weight, diagnosis and component availability pooled vs apheresis will influence the blood banks decision about what product to supply. An ABO incompatible platelet transfusions group O platelets given to a group A patient may be associated with clinically significant transfusion reactions, including a positive DAT, red cell haemolysis and even lower platelet survival in some patients. Platelet components contain a small number of red cells that could be Rh incompatible with the recipient.
Therefore RhD negative females with childbearing potential should receive platelet transfusions from RhD negative donors. If transfusion of RhD positive product to RhD negative recipient is unavoidable, consider giving Rhesus immunoglobulin Discuss with haematologist-on-call.
Clinical situation to trigger platelet transfusion. These patients should receive platelet transfusions with clinically significant bleeding only. Clinical situation to trigger platelet transfusion in neonates. Term or preterm infant with symptomatic thrombocytopenia and minor bleeding, coagulopathy or prior to surgery. Term or preterm infant with symptomatic thrombocytopenia and major bleeding or requiring major surgery e. Where possible, a platelet product compatible with both donor and recipient should be used.
At RCH the platelet product choice for each transplant recipient will be specified by their transplant physician and will be listed on the Transplant Protocol.
Platelet transfusion in rare congenital platelet disorders such as Bernard-Soulier syndrome, Glanzmann's thrombasthenia, thrombocytopenia with absent radii TAR , Wiskott-Aldrich syndrome, Fanconi anaemia, amegakaryocytic thrombocytopenia can provoke the development of multi-specific HLA or platelet specific antibodies and they should be used sparingly.
They should be reserved for clinical bleeding or prior to invasive procedures with a high risk of bleeding. Donor exposure should be limited through the use of apheresis platelets and the risk of alloimmunisation reduced through the use of leukocyte reduced products.
Transfused platelets are rapidly destroyed and should be reserved for cases of life-threatening bleeding. Apheresis platelets can be used to reduce donor exposure in chronically transfused patients. The infant or fetus with confirmed or suspected alloimmune thrombocytopenia should be transfused platelets which are negative for the implicated alloantigen.
Contact the haematologist-on-call for advice regarding platelet support in this clinical situation. When patients fail to achieve a significant and sustained rise in the platelet count following platelet transfusion platelet increment they are said to be 'refractory'.
If this affects you, talk to your doctor about other treatments or ways to manage a low platelet count. Platelets come from people who donate their blood. In most cases, platelets do not need to be matched to your blood group in the same way as a blood transfusion. The platelets for transfusion are yellow-coloured and stored in small plastic bags. Platelets are given by a drip infusion into one of your veins.
A nurse will put a short, thin tube cannula into a vein in your arm or hand. This is then connected to a drip. If you have a central line or PICC line , your nurse can connect this to your drip instead. The transfusion usually takes 15 to 30 minutes. You may have it in an outpatient clinic, in a day unit, or as an inpatient. The transfusion increases the number of platelets in your blood straight away. But sometimes the benefits do not last long, and you may need more transfusions.
During the transfusion, your nurse will regularly check your temperature, pulse and blood pressure. This is to make sure you are not having a reaction to the platelets. The nurses will check you for any reactions. They will stop the transfusion and quickly treat any symptoms. Tell your nurse straight away if you feel unwell during your transfusion. Rarely, if you have had lots of platelet transfusions, your platelet count may not improve after a transfusion.
This is called becoming refractory or resistant to platelets. If this happens, you will have tests to find the cause. You may be given platelets that are better matched to your own. Some people worry that the platelets they are given may be infected by disease. People who donate blood or platelets are carefully screened for infections or viruses such as hepatitis or HIV.
This is to make sure the donations are as safe as possible. All donated platelets are tested in the laboratory for infection. Very rarely, there may be an infection in the platelets that is not found by these tests. But the risk of being given infected platelets is very small. If you have any concerns about receiving a platelet transfusion, talk to your doctor or specialist nurse. Irradiated blood products lower the risk of the donated cells reacting against your own.
The radiation will not damage the blood product or make you radioactive. Your doctor will record in your medical notes if you should only have irradiated blood products. They will also give you a special card to carry, in case you are treated at another hospital. Keep this card with you at all times and remind your hospital team that you need irradiated blood or platelets. Author information Copyright and License information Disclaimer.
Corresponding author. Neil Blumberg: ude. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You may not use this work for commercial purposes. This article has been cited by other articles in PMC. Abstract Over the last half century, platelet transfusion has been an effective therapy for the prevention and treatment of bleeding, particularly in patients with hematologic malignancies.
Introduction and context Source, dose, benefits, risks, and prophylactic transfusion triggers The goal of platelet transfusion is to stop or prevent bleeding in thrombocytopenic patients or those with platelet dysfunction [ 1 - 3 ]. Risks Patients receiving pheresis platelets are likely to have a higher risk of hemolytic reactions if they are ABO-mismatched [ 5 - 7 ] and a higher risk of acute lung injury transfusion-related acute lung injury due to having larger amounts of plasma from a single donor, but carry a lower risk of infectious disease transmission due to fewer donor exposures.
Indications Traditionally, platelet transfusions in hematology-oncology have been given prophylactically as serious bleeding is fortunately uncommon in these patients. Platelet transfusion refractoriness If refractoriness to platelet transfusion poor post-transfusion platelet count increments is suspected, this is evaluated primarily by immediate post-transfusion count increments approximately minutes after completion of the transfusion.
Recent advances Recent data suggest the efficacy and safety of transfusing fewer and lower doses of platelet transfusions. References 1. Platelet transfusion therapy: from to Hum Immunol. Slichter SJ. Platelet transfusion therapy. Hematol Oncol Clin North Am.
Heal JM, Blumberg N. Optimizing platelet transfusion therapy. Blood Rev. Background, rationale, and design of a clinical trial to assess the effects of platelet dose on bleeding risk in thrombocytopenic patients.
J Clin Apher. Repeat ABO-incompatible platelet transfusions leading to haemolytic transfusion reaction. Transfus Med. Acute hemolytic transfusion reaction in a pediatric patient following transfusion of apheresis platelets.
The Trial to Reduce Alloimmunization to Platelets Study Group Leukocyte reduction and ultraviolet B irradiation of platelets to prevent alloimmunization and refractoriness to platelet transfusions.
N Engl J Med. The role of ABO matching in platelet transfusion. Eur J Haematol. Platelet washing to prevent recurrent febrile reactions to leucocyte-reduced transfusions. Lowering the prophylactic platelet transfusion threshold: A prospective analysis. Leuk Lymphoma. The threshold for prophylactic platelet transfusions in adults with acute myeloid leukemia. The clinical impact of platelet refractoriness: correlation with bleeding and survival. A therapeutic platelet transfusion strategy is safe and feasible in patients after autologous peripheral blood stem cell transplantation.
Bone Marrow Transplant. Platelet transfusions during coronary artery bypass graft surgery are associated with serious adverse outcomes. Platelet transfusion during liver transplantation is associated with increased postoperative mortality due to acute lung injury. Anesth Analg. J Womens Health Larchmt ; 16 —
0コメント