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.
- Guidance for transfusing platelets across blood groups (PDF)
- NBTC platelet indication codes (JPAC website)
- NBTC platelet shortage plan (JPAC website)
- SHOT key messages for febrile, allergic and hypotensive reactions (FAHR) (SHOT website)
- Summary of BSH platelet guidance 2016 (reviewed May 2019, BSH website)
- Apheresis platelets myth buster poster (PDF)
- Conserving the supply of A D Negative platelets (PDF)
- HLA matched platelets poster (PDF) - this poster cannot be ordered but is available for download here
- Platelet indication code bookmark and poster (under review - February 2020)
- Poster providing guidance on ordering HLA/HPA selected platelets available on the Histocompatibility and Immunogenetics (H&I) page
- Poster and screen saver to promote single unit platelet doses for prophylactic transfusions, A4 size (PDF) - these items cannot be ordered but are available for download here
- Will I need a platelet transfusion? (PDF) - this cannot be ordered but is available for download here
- Audit of the use of platelets in three UK Transfusion Committee regions - (NICE website)
- Haematology national comparative re-audit 2017
- Platelet audit template (BSH website)
- Nursing Times Article – Strategies to reduce inappropriate use of platelet transfusions (Nursing Times website)
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.
The platelet action group have translated five key messages on the safe and appropriate use of platelets into infographics. They have been designed to be used in teaching of clinical and transfusion laboratory staff. Please note the messages are not aimed at patients. They are free to use to supplement your teaching sessions, but please acknowledge the Platelet Action group.
- If you stock platelets establish a strategy to maximise transfusion of ABO/D compatible units (PPT)
- The use of platelets of a different group should be limited to patients where: (PPT)
- Don't use two when one will do (PPT)
- Prophylactic platelets are NOT required (PPT)
- CMV negative platelets are rarely needed: do not order unless the patient requires them (PPT)