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:
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%.
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.
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.
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.
- Guidance for transfusing platelets across blood groups
- 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
- HLA matched platelets poster - not available for ordering but you can download this file
- Platelet indication code bookmark and poster (under review at 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 - not available for ordering but you can download these files
- Will I need a platelet transfusion? - not available for ordering but you can download this file
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 of the use of platelets in three UK Transfusion Committee regions (NICE website)
- Haematology national comparative re-audit 2017
- Platelet audit template (BSH website)
- Strategies to reduce inappropriate use of platelet transfusions (Nursing Times website)
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.
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.
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.
Text version: don't use two when one will do. One adult therapeutic dose of platelets is required for prophylaxis.
Text version: prophylactic platelets are not required:
a) prior to bone marrow aspirate and trephine b) in stable patients with chronic bone marrow failure.
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.