Platelet Transfusions

Published on 25/03/2015 by admin

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Last modified 25/03/2015

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Chapter 465 Platelet Transfusions

Ronald G. Strauss

Guidelines for platelet (PLT) support of children and adolescents with quantitative and qualitative PLT disorders are similar to those for adults (see imageTable 465-1 on the Nelson Textbook of Pediatrics website at www.expertconsult.com), in whom the risk of life-threatening bleeding after injury or occurring spontaneously can be related to the severity of thrombocytopenia. PLT transfusions should be given to patients with PLT counts < 50 × 109/L when they are bleeding or are scheduled for an invasive procedure, and the PLT count should be maintained > 50 × 109/L until bleeding ceases or the patient is stable after the procedure.

Table 465-1 GUIDELINES FOR PEDIATRIC PLATELET (PLT) TRANSFUSION*

CHILDREN AND ADOLESCENTS

PLT count < 50 × 109/L and bleeding
PLT count < 50 × 109/L and an invasive procedure
PLT count < 20 × 109/L and marrow failure with hemorrhagic risk factors
PLT count < 10 × 109/L and marrow failure without hemorrhagic risk factors
PLT count at any level, but with PLT dysfunction plus bleeding or an invasive procedure

INFANTS ≤ 4 MO OLD

PLT count < 100 × 109/L and bleeding or during extracorporeal membrane oxygenation
PLT count < 50 × 109/L and an invasive procedure
PLT count < 20 × 109/L and clinically stable
PLT count < 50 × 109/L and clinically unstable
PLT count at any level, but with PLT dysfunction plus bleeding or an invasive procedure

* Words in italics must be defined for local transfusion guidelines.

Studies of patients with thrombocytopenia resulting from bone marrow failure indicate that the risk of spontaneous bleeding increases markedly when PLT levels fall to < 20 × 109/L, and hemorrhagic risk factors (infection, organ failure, clotting abnormalities, mucosal lesions, severe graft versus host disease, or anemia) are present. In this high-risk setting, prophylactic PLT transfusions are given to maintain a PLT count > 20 × 109/L. This threshold has been challenged by studies of adult patients, who in many instances were selected to be in relatively good clinical condition without hemorrhagic risk factors. Consequently, a lower PLT transfusion trigger of 5-10 × 109

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