Platelets toolkit

How and when to use platelets

The British Society for Haematology provides the following guidance:

Summary of guidelines for the use of platelet transfusions (PDF 47KB)

You can also find indication codes for transfusion and a platelet shortage plan on the National Blood Transfusion Committee (NBTC) recommendations page:

NBTC recommendations

Ordering platelets and appropriate substitutions

NHS Blood and Transplant (NHSBT) provides the following resources:

• Transfusing platelets across blood groups (PDF 141KB)
• Ordering HPA platelets
• Ordering HLA platelets
• HLA selected platelet FAQ
• Portfolio of blood components and guidance for their clinical use
  

Risk reduction measures for vCJD

The Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) created the following report:

Guidance on platelets, apheresis, vCJD on GOV.UK

Here are some key recommendations for using platelets in a selection of clinical scenarios. We have also included general information on substitutions and high specification component ordering.

Emergency use

Consider using A D positive platelets in emergencies.

It is acceptable to use ABO incompatible platelets negative for high titre agglutinins (HT) in the management of adult patients with major haemorrhage.

Females under 50 years of age

Use D negative platelets for females under 50 years of age whose blood group is unknown.

If ABO group is known

Use ABO matched platelets if possible. These give the highest platelet count increment and are in the patient’s best interest rather than group A platelets. This may not be possible if a patient requires HLA or HPA-selected platelets.

HLA or HPA matched platelets

To ensure appropriate use, requests for HLA or HPA matched platelets should be approved by a clinician and reviewed regularly.

Please use the form that accompanies the platelets to record the increment data and return it to NHSBT. This enables us to measure the effectiveness of the treatment and assess the need for further HLA or HPA matched platelets.

Appropriate management of stock

You should regularly review ordering patterns, activity, and wastage. Contact your Customer Service Manager or the Blood Stocks Management Scheme for advice or see current Blood Stocks Management Scheme resources.

• Avoid holding A D negative platelets as stock: ABO matched platelets give the highest platelet count increment and are in the patient’s best interest rather than A D negative units. Using A D negative as a ‘universal’ component contributes to more than 15% of total platelet demand from a potential donor population of only 7%.
  
  
• Group AB platelets: AB D negative platelets should only be ordered for named patients. Please note, demand continues to exceed supply, and requests may be met with non-ABO matched substitutions.
  
  
• Orders for high specification components: For high specification components such as apheresis, CMV negative, and HT (high titre) negative we issue on a ‘first in first out’ basis. Orders may be challenged to reduce wastage.
  
  
• Substitutions: Demand for A D negative is highly variable, complicating the supply chain of this short shelf-life component. To meet times of high demand we collect beyond the proportionate donor population to ensure appropriate supply to all stock holding units. When demand is low, older A D negative units may be supplied, where appropriate, within expiry date, to reduce wastage.

Use this poster to reinforce the importance of measuring the platelet count after every HLA matched transfusion:

HLA matched platelets (PDF 681KB)