Previous national comparative audits of platelet transfusions and the use of platelets in haematology have indicated evidence of inappropriate administration, with platelet transfusions occurring outside confirmed guidelines. NHS Blood and Transplant have produced the following resources and collaborated with hospitals to support the appropriate use of platelets and reduce avoidable wastage.
- Platelet audit template (BSH website)
- Summary of BSH platelet guidance 2016 (PDF)
- Apheresis Platelets Myth Buster poster (PDF)
- NBTC platelet indication codes June 2016
- Indications bookmark and poster
- Appropriate use of platelets across blood groups (PDF)
- SHOT key messages for ATRs – platelets in PAS (SHOT website)
- Blood Stocks Management Scheme Platelet Stockholding Algorithm (PDF)
- Poster to promote single unit platelet doses for prophylactic transfusions , A4 size (PDF)
- Haematology national comparative audit 2016, full report and key findings (PDF)
- Audit of the Use of Platelets in Three UK Transfusion Committee Regions
- Appropriate use of platelets - teaching slide set (coming soon)
- Nursing Times Article – Strategies to reduce inappropriate use of platelet transfusions
- London Platelet Action Group top ten tips for HTTs (PDF)
- HLA/HPA Selected Platelets poster - information for healthcare professionals (PDF)
- HLA Matched Platelets poster (PDF)
- Will I need a platelet transfusion? (PDF)
Use of prophylactic platelet transfusions
The TOPPS study, published in the New England Journal of Medicine in May 2013, was an international multi centre trial that evaluated whether a policy of not giving prophylactic platelet transfusions was as safe and effective as providing prophylaxis to patients with haematological malignancies.
The primary end point was bleeding, assessed using a modified WHO bleeding scale. The study showed that WHO grade 2 - 4 bleeding occurred in 50% of patients in the no-prophylaxis group compared to 43% in the prophylaxis group. Platelet usage was markedly reduced in the no-prophylaxis group. There was no difference in length of stay in hospital or serious adverse events between the prophylaxis or non-prophylaxis groups.
The results therefore support the continuing use of platelet prophylaxis in patients with haematological malignancy and thrombocytopenia, although further studies are required to improve understanding of risk factors for bleeding.