Platelet Transfusions

Published on 25/03/2015 by admin

Filed under Pediatrics

Last modified 25/03/2015

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Chapter 465 Platelet Transfusions

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.

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