When is platelet transfusion necessary

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.

White blood cell transfusions are given rarely. Research does not show that giving white blood cell transfusions lowers the risk of death or infection in people with low white blood cell counts or white blood cells that are impaired. Instead of transfusing WBCs, doctors now commonly use drugs called colony-stimulating factors or growth factors to help the body make its own.

These drugs stimulate the body to make neutrophils and other types of granulocytes. The American Cancer Society medical and editorial content team. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

November Accessed at www. Babic A, Kaufman RM. Principles of platelet transfusion therapy. Hematology: Basic Principles and Practice. Philadelphia, Pa: Churchill Livingstone; Cata JP. Perioperative anemia and blood transfusions in patients with cancer: when the problem, the solution, and their combination are each associated with poor outcomes.

Cochrane Database of Systematic Reviews. Granulocyte transfusions for treating infections in people with neutropenia or neutrophil dysfunction. Principles of red blood cell transfusion. Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Domen RE. Blood Product Transfusions in the Hematologic Malignancies. Clinical Malignant Hematology. New York: McGraw-Hill; Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival.

Tech Coloproctol. Glaspy J. Disorders of blood cell production in clinical oncology. A Compendium of Transfusion Practice Guidelines. Second Edition Transfusion indications for patients with cancer.

Cancer Control. It has been reviewed by expert medical and health professionals and people living with cancer. Platelet transfusions. Platelets are cells that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets and you may need a platelet transfusion. On this page. What are platelets?

A low platelet count can increase your risk of bleeding. What is a platelet transfusion? Why do I need a platelet transfusion? Signs of a low platelet count include: nosebleeds heavy periods bruising tiny blood spots under the skin petechiae bleeding gums.

Tell your doctor straight away if you notice any of these symptoms. Decisions about treatment Before you have a transfusion, your doctor will explain why it is being given. Having a platelet transfusion Platelets come from people who donate their blood.

Platelet infusion duration The transfusion usually takes 15 to 30 minutes. Possible side effects of platelet transfusions Reactions to the platelets During the transfusion, your nurse will regularly check your temperature, pulse and blood pressure.

Some people may have: shivering a rise in temperature itching a skin rash. Contact the hospital if you have any problems after you get home. Becoming resistant refractory to platelets Rarely, if you have had lots of platelet transfusions, your platelet count may not improve after a transfusion.

Are platelet transfusions safe? Irradiated blood products Some people may need to have blood products that have been treated with irradiation. You may need irradiated blood products if you have had: Hodgkin lymphoma certain chemotherapy drugs certain targeted therapies a stem cell transplant.

Your doctor will tell you if this applies to you. About our information References. Print page. How we can help. Information from references 12 and Transfusion-related complications can be categorized as acute or delayed, which can be divided further into the categories of noninfectious Table 5 16 and infectious Table 6 16 , Therefore, patients are far more likely to experience a noninfectious serious hazard of transfusion than an infectious complication.

Mistransfusion transfusion of the incorrect product to the incorrect recipient. Noninfectious serious hazards of transfusion. Anesth Analg. I nformation from references 16 and Hemolytic transfusion reactions are caused by immune destruction of transfused RBCs, which are attacked by the recipient's antibodies.

The antibodies to the antigens of the ABO blood group or alloantibodies to other RBC antigens are produced after immunization through a previous transfusion or pregnancy. There are two categories of hemolytic transfusion reactions: acute and delayed. Nonimmune causes of acute reactions include bacterial overgrowth, improper storing, infusion with incompatible medications, and infusion of blood through lines containing hypotonic solutions or small-bore intravenous tubes.

In acute hemolytic transfusion reactions, there is a destruction of the donor's RBCs within 24 hours of transfusion. Hemolysis may be intravascular or extravascular. The most common type is extravascular hemolysis, which occurs when donor RBCs coated with immunoglobulin G IgG or complement are attacked in the liver or spleen. Symptoms of acute hemolytic transfusion reactions include fever, chills, rigors, nausea, vomiting, dyspnea, hypotension, diffuse bleeding, hemoglobinuria, oliguria, anuria, pain at the infusion site; and chest, back, and abdominal pain.

The incidence of acute hemolytic reactions is approximately one to five per 50, transfusions. Allergic reactions range from mild urticarial to life threatening anaphylactic. Urticarial allergic reactions are defined by hives or pruritus.

These antigens are soluble, and the associated reaction is dose-dependent. Allergic transfusion reactions occur in 1 to 3 percent of transfusions. Patients with anaphylactic transfusion reactions, like those with urticarial reactions, may present with hives, but they are distinct in that they also develop hypotension, bronchospasm, stridor, and gastrointestinal symptoms.

For example, anaphylaxis occurs because of donor IgA being infused into a recipient who is IgA deficient and has preexisting circulating anti-IgA. Prevention of anaphylactic transfusion reactions includes avoiding plasma transfusions with IgA in patients known to be IgA deficient. Cellular products e. Transfusion-related acute lung injury TRALI is noncardiogenic pulmonary edema causing acute hypoxemia that occurs within six hours of a transfusion and has a clear temporal relationship to the transfusion.

Antineutrophil cytoplasmic antibodies or anti-HLA antibodies activate the recipient's immune system, resulting in massive pulmonary edema. Donor products that contain large amounts of plasma from multiparous women are associated with TRALI. Mortality in the United Kingdom decreased significantly after donor plasma from men was used exclusively.

Two mechanisms have been proposed to explain FNHTRs: a release of antibody-mediated endogenous pyrogen, and a release of cytokines. Common cytokines that may be associated with FNHTRs include interleukin-1, interleukin-6, interleukin-8, and tumor necrosis factor.

Transfusion-associated circulatory overload is the result of a rapid transfusion of a blood volume that is more than what the recipient's circulatory system can handle. It is not associated with an antibody-mediated reaction. Those at highest risk are recipients with underlying cardiopulmonary compromise, renal failure, or chronic anemia, and infants or older patients.

Cardiomegaly and pulmonary edema are often seen on chest radiography. The diagnosis is made clinically, but may be assisted by measuring brain natriuretic peptide levels, which are elevated in response to an increase in filling pressure.

Transfusion-associated graft-versus-host disease is a consequence of a donor's lymphocytes proliferating and causing an immune attack against the recipient's tissues and organs. It is fatal in more than 90 percent of cases.

Risk factors include a history of fludarabine Oforta treatment, Hodgkin disease, stem cell transplant, intensive chemotherapy, intrauterine transfusion, or erythroblastosis fetalis. Other probable risk factors include a history of solid tumors treated with cytotoxic drugs, transfusion in premature infants, and recipient-donor pairs from homogenous populations.

Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. LISA N. Reprints are not available from the authors. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med. Transfusion strategies for patients in pediatric intensive care units.

King KE, Bandarenko N. Bethesda, Md. Red blood cell transfusion in clinical practice. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists clinical practice guideline. Ann Thorac Surg. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev.

Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets.