Platelet transfusion

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Platelet transfusion
Platelet blood bag.jpg
A bag of platelets
Clinical data
ATC code

Platelet transfusion, also known as platelet concentrate, is used to treat or prevent bleeding in people with either a low platelet count or poor platelet function. Often this occurs in people receiving cancer chemotherapy.[1] Preventative transfusion is often done in those with platelet levels of less than 10 x 109/L. In those who are bleeding transfusion is typically carried out at less than 50 x 109/L. Cross matching is typically required before platelets are given.[2] They are given by injection into a vein.[3]

Side effects can include allergic reactions such as anaphylaxis, infection, and lung injury. Bacterial infections are relatively more common with platelets as they are stored at warmer temperatures.[2] Platelets can be gotten either from whole blood or by apheresis. They keep for up to five to seven days.[1]

Platelet transfusions came into medical use in the 1950s and 1960s.[1][4] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[5] In the United Kingdom it costs the NHS about 200 pounds per unit.[6] Some versions of platelets have had the white blood cells partially removed or been gamma irradiated which have specific benefits for certain populations.[7]

Medication use[edit]

International guidelines recommend that platelets transfusions are given to people with reversible bone marrow failure to reduce the risk of spontaneous bleeding when the platelet count is less than 10 x 109/L.[8][9][10]

Prevention versus treatment[edit]

A review in people with haematological malignancies found that overall giving platelet transfusions when the platelet count is less than 10 x 109/L reduced the number of bleeding events and days with significant bleeding.[11] However, this benefit was only seen in certain patient groups, and people undergoing an autologous stem cell transplant derived no obvious benefit.[11]

Dose[edit]

A review in people with haematological malignancies compared different platelet transfusion doses.[12] This review found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets (low dose - 1.1 x 1011/m2) and those that contained an intermediate number of platelets (intermediate dose - 2.2 x 1011/m2). This review also found no difference in the number of people who had clinically significant bleeding between platelet transfusions that contained a small number of platelets and those that contained a large number of platelets (high dose - 4.4 x 1011/m2).[12] One of the review's included studies reported on transfusion reactions. This study’s authors suggested that a high-dose platelet transfusion strategy may lead to a higher rate of transfusion-related adverse events.[13]

Usage[edit]

People with cancer receive the largest proportion of platelet transfusions as they are an important supportive therapy during treatment with chemotherapy or stem cell transplant.[14][15][16] Much of the remainder are used in general medicine, cardiac surgery and in intensive care.[14][15][16]

Unlike other blood products demand for platelet transfusions appears to be increasing in several countries around the world.[17] An ageing population, an increase in the number of people with blood cancer, and changes to the management of these cancers are likely the major reasons for the rise in demand for platelets.[17] Since 1990, the number of stem cell transplants performed in Europe has risen from 4,200 to over 30,000 annually.[18]

References[edit]

  1. ^ a b c Hillyer, Christopher D. (2007). Blood Banking and Transfusion Medicine: Basic Principles & Practice. Elsevier Health Sciences. p. 308-310. ISBN 0443069816. 
  2. ^ a b Connell, NT (December 2016). "Transfusion Medicine.". Primary care. 43 (4): 651–659. PMID 27866583. 
  3. ^ Linton, Adrianne Dill (2015). Introduction to Medical-Surgical Nursing. Elsevier Health Sciences. p. 287. ISBN 9781455776412. 
  4. ^ Das, P. C.; Smit-Sibinga, C. T. h; Halie, M. R. (2012). Supportive therapy in haematology. Springer Science & Business Media. p. 190. ISBN 9781461325772. 
  5. ^ "WHO Model List of Essential Medicines (19th List)" (PDF). World Health Organization. April 2015. Retrieved 8 December 2016. 
  6. ^ Yentis, Steven M.; Hirsch, Nicholas P.; Ip, James (2013). Anaesthesia and Intensive Care A-Z: An Encyclopedia of Principles and Practice. Elsevier Health Sciences. p. 147. ISBN 9780702053757. 
  7. ^ Hillyer, Christopher D. (2007). Blood Banking and Transfusion Medicine: Basic Principles & Practice. Elsevier Health Sciences. p. 320. ISBN 0443069816. 
  8. ^ Kaufman, Richard M.; Djulbegovic, Benjamin; Gernsheimer, Terry; Kleinman, Steven; Tinmouth, Alan T.; Capocelli, Kelley E.; Cipolle, Mark D.; Cohn, Claudia S.; Fung, Mark K. (2015-02-03). "Platelet Transfusion: A Clinical Practice Guideline From the AABB". Annals of Internal Medicine. 162 (3): 205–213. doi:10.7326/M14-1589. ISSN 0003-4819. PMID 25383671. 
  9. ^ "Blood transfusion | Guidance and guidelines | NICE". www.nice.org.uk. Retrieved 2016-01-21. 
  10. ^ "Patient Blood Management Guidelines | National Blood Authority". www.blood.gov.au. Retrieved 2016-01-21. 
  11. ^ a b Crighton, Gemma L.; Estcourt, Lise J.; Wood, Erica M.; Trivella, Marialena; Doree, Carolyn; Stanworth, Simon (2015-01-01). "A therapeutic-only versus prophylactic platelet transfusion strategy for preventing bleeding in patients with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 9: CD010981. doi:10.1002/14651858.CD010981.pub2. ISSN 1469-493X. PMC 4610062Freely accessible. PMID 26422767. 
  12. ^ a b Estcourt, Lise J.; Stanworth, Simon; Doree, Carolyn; Trivella, Marialena; Hopewell, Sally; Blanco, Patricia; Murphy, Michael F. (2015-01-01). "Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation". The Cochrane Database of Systematic Reviews. 10: CD010984. doi:10.1002/14651858.CD010984.pub2. ISSN 1469-493X. PMC 4724938Freely accessible. PMID 26505729. 
  13. ^ Kaufman, Richard M.; Assmann, Susan F.; Triulzi, Darrell J.; Strauss, Ronald G.; Ness, Paul; Granger, Suzanne; Slichter, Sherrill J. (2015-01-01). "Transfusion-related adverse events in the Platelet Dose study". Transfusion. 55 (1): 144–153. doi:10.1111/trf.12791. ISSN 1537-2995. PMC 4293226Freely accessible. PMID 25065959. 
  14. ^ a b Cameron, Bruce; Rock, Gail; Olberg, Bernard; Neurath, Doris (2007-02-01). "Evaluation of platelet transfusion triggers in a tertiary-care hospital". Transfusion. 47 (2): 206–211. doi:10.1111/j.1537-2995.2007.01090.x. ISSN 0041-1132. PMID 17302765. 
  15. ^ a b Charlton, A.; Wallis, J.; Robertson, J.; Watson, D.; Iqbal, A.; Tinegate, H. (2014-08-01). "Where did platelets go in 2012? A survey of platelet transfusion practice in the North of England". Transfusion Medicine (Oxford, England). 24 (4): 213–218. doi:10.1111/tme.12126. ISSN 1365-3148. PMID 24957661. 
  16. ^ a b Whitaker, Barbee I; Rajbhandary, Srijana; Harris, Angela (2015). The 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey Report. AABB. 
  17. ^ a b Estcourt, L. J. (2014-10-01). "Why has demand for platelet components increased? A review". Transfusion Medicine (Oxford, England). 24 (5): 260–268. doi:10.1111/tme.12155. ISSN 1365-3148. PMID 25327286. 
  18. ^ Passweg, J. R.; Baldomero, H.; Gratwohl, A.; Bregni, M.; Cesaro, S.; Dreger, P.; de Witte, T.; Farge-Bancel, D.; Gaspar, B. (2012-07-01). "The EBMT activity survey: 1990-2010". Bone Marrow Transplantation. 47 (7): 906–923. doi:10.1038/bmt.2012.66. ISSN 1476-5365. PMID 22543746. 

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