Platelets

We are asking clinical and laboratory colleagues to review ordering and stockholding practice, and question historical platelet use.

Addendum to the BSH haematological management of major haemorrhage guideline

The addendum supports the use of ABO incompatible units when the blood group is unknown and the selection of D negative units for specific patient groups.

It was added in 2017 to the 2015 guidelines relating to appropriate use of platelets in major haemorrhage.

Support and follow our recommendations:

Emergency use 

It is acceptable to use ABO incompatible platelets negative for high titre agglutinins in the management of patients with major haemorrhage. D negative platelets should be used for females <50 years of age of unknown blood group. 

In the absence of HLA or HPA

ABO matched platelets give the highest platelet count increment and are in the patient’s best interest.

AB D neg

These platelets should only be ordered for named patients. Demand continues to exceed supply and requests may be met with non-ABO matched substitutions.

A D neg

When time permits, match ABO group, rather than rely on A D neg platelets. Using these platelets as a ‘universal’ component contributes to >17% of total platelet demand from a potential donor population of only 7%.

Substitutions

Demand for A D neg is highly variable which complicates the supply chain of this short shelf-life product. 

To be able to supply highest demand we collect beyond the proportionate donor population to supply all stock holding units to this level.

When demand is low, we may offer older A D neg units for group acceptable substitutions in date of expiry order to reduce wastage of this valuable resource.

We issue a ‘first in first out’ process, orders for high spec such as Apheresis, CMV and HT negative may have their appropriateness questioned to reduce wastage. 

Stockholding

You should regularly review ordering patterns, activity and wastage. Contact your Customer Service Manager or the Blood Stocks Management Scheme for advice on stocking an alternative to A D neg.

 

National guidance

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. 

 

NHSBT guidance
Research
Lower transfusion threshold may prevent death or major bleeding in 7 out of 100 premature neonates with severe thrombocytopenia

A Randomised Trial of Neonatal Platelet Transfusion Thresholds reported the outcomes of the PlaNet 2 study which looked at platelet transfusion in premature babies. The 6-year study involved a total of 43 paediatric/neonatal units in the UK, Ireland and the Netherlands and recruited a total of 660 premature babies with severe thrombocytopenia.

The study found that the use of a higher platelet count threshold as a trigger for prophylactic platelet transfusion was associated with a worse combined outcome of mortality and major bleeding compared to a lower threshold in the 28 days after randomisation.

Platelet transfusion seems inferior to standard care after acute intracerebral haemorrhage in people taking antiplatelet therapy

The PATCH study "Platelet transfusion versus standard care after acute stroke" (Lancet, June 2016) was a randomised trial that investigated the effect of platelet transfusion after intracerebral haemorrhage associated with antiplatelet therapy use.

The results indicate that platelet transfusion seems inferior to standard care after acute intracerebral haemorrhage in people taking antiplatelet therapy. This study did not recommend platelet transfusion for this indication pending the results of another similar randomised trial.

Evaluation whether a policy of not giving prophylactic platelet transfusions was as safe and effective as providing prophylaxis to patients with haematological malignancies

The results of this TOPPs study, an international multi-centre trial, 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.

See our poster for a summary of the findings.

Audit
Article

Infographics

The images here are available to download as PowerPoint files at the bottom of this of page.

Free infographics to supplement your teaching sessions

These are the images on this page which you can download. They have been designed to be used in teaching of clinical and transfusion laboratory staff, and are not aimed at patients. We would appreciate you acknowledging the Platelet Action Group if you use them.

If you stock platelets establish a strategy to maximise transfusion of ABO/D compatible units (PPT)

Text version: if you stock platelets, establish a strategy to maximise transfusion of ABO/D compatible units. Images shown of A positive, O positive and O negative platelet units.

The use of platelets of a different group should be limited to patients where: (PPT)

Text version: the use of platelets of a different group should be limited to patients where:

a) the blood group is unknown b) there is a need to prevent wastage due to time expiry c) specific requirements are necessary d) time does not allow.

Don't use two when one will do (PPT)

Text version: don't use two when one will do. One adult therapeutic dose of platelets is required for prophylaxis.

Prophylactic platelets are NOT required (PPT)

Text version: prophylactic platelets are not required:

a) prior to bone marrow aspirate and trephine b) in stable patients with chronic bone marrow failure.

CMV negative platelets are rarely needed: do not order unless the patient requires them (PPT)

Text version: CMV negative platelets are rarely needed: do not order them unless the patient requires them:
a) intra-uterine transfusion (IUT) b) neonatal transfusion up to 28 days post EDD c) elective transfusion during pregnancy. Not labour or delivery.