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10 Importance of Platelet Transfusion

Platelet Transfusion
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Low MPV as well as low platelet count in the blood stream may occur due to various medical or hereditary reasons. When such situations happen, the number of platelets in the blood is considerably lower than the required levels. This increases the risk of bleeding because platelets are responsible for blood clot formation. The situation may cause nosebleeds, heavier periods, bleeding gums, bruising or more serious blood disorders. If the amount of platelets is very low, doctors will recommend a platelet transfusion and on consent, the patient will be given platelets collected from viable donors. The donated platelets are run through a drip into the bloodstream of the patient. This transfusion takes a duration ranging between 15 to 30 minutes and can be done at an outpatient clinic. Side effects are rare since all donated platelets are adequately tested for infections or viruses.

Platelet transfusions are used for therapeutic treatment of patients with bleeding due to severe decrease in platelet production or platelets that are abnormally functioning. The transfusion may be given when the platelet count is lower than 50 x 109 /L like in cases of diffuse microvascular bleeding. Platelets need to be given as prophylaxis to patients who experience rapidly falling or low platelet counts. Such situations may be a count of less than 10 x 109 /L which may be caused by cancer, chemotherapy or bone marrow failure in the absence of risk factors, less than 20 x 109 /L in bone marrow failure without additional risk factors such as fever, antibiotics or past cases of systemic haemostatic failure. Also, it can be done for the purpose of maintaining a count of more than 50 x 109 /L for surgical procedures, as well as more than 100 x 109 /L for surgeries that have a higher risk of bleeding such as ocular or neurosurgery.

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Today, the number of alternatives to platelet transfusion is limited, especially for the acute treatment of bleeding associated with thrombocytopenia. Longer term alternatives such as discontinuation of drugs which affect platelet function, some other strategies to increase platelet production, and treatment of underlying conditions are used as alternatives to the transfusion.

Platelet Transfusion

Platelet transfusion is very important to patients with lower platelet count. The transfusions have been found to be ineffective in patients with rapid platelet destruction. Also, transfusion procedure may be used in treatment of some bleeding patients who are experiencing platelet consumption or dilutional thrombocytopenia.

1. Replaces blood lost after surgery or trauma

Patients undergoing massive blood loss from trauma or surgery are transfused with red blood cells; resulting in partial replacement of the blood volume, fresh frozen plasma, and random donor platelet units in a ratio of 1:1:1. Thus, a patient transfused with six units of red blood cells will also get six units of platelets or one apheresis unit, providing approximately 5 x 1011 platelets and six units of fresh frozen plasma. This will help generate the lost blood cells.

2. Cardiopulmonary bypass

Individuals undergoing prolonged cardiopulmonary bypass are likely to have thrombocytopenia as well as impaired platelet function. Platelet transfusion plays an important role in replacement of platelets in the blood stream in the cardiopulmonary bypass setting.

3. Saves patients with thrombocytopenia

Platelet transfusion has proven to be lifesaving in bleeding patients with thrombocytopenia (reduced platelet function). The platelets are transfused in any patient who is losing blood with a platelet count of less than 50,000/microL (100,000/microL for central nervous system, ocular bleeding or in patients with an acquired and inherited platelet defect regardless of count. Platelet transfusion also saves situations where thrombocytopenic patients will be undergoing invasive medical procedures.

4. Prevention of bleeding in afebrile patients

Prophylactic platelet transfusion is used to prevent spontaneous bleeding in afebrile patients with platelet counts that are 10,000/microL resulting from bone marrow suppression. Individuals with acute promyelocyticleukemia (APL) are known to have a coexisting coagulopathy thus, a platelet transfusion threshold of 30,000 to 50,000/microL is used in these patients. Higher thresholds are used in patients who are known to be febrile or septic.

5. Used in patients with platelet consumption disorders

Patients with platelet consumption disorders such as heparin-induced thrombocytopenia (HIT), immune thrombocytopenia (ITP), thrombotic thrombocytopenic purpura (TTP), liver disease, disseminated intravascular coagulation (DIC) and those with platelet function disorders; are transfused for bleeding and invasive procedures. Platelets transfusion needs not to be withheld in patients with the above conditions for fear of increasing the level of thrombosis.

6. Used in patients undergoing other medications that impair platelet function

Some medications impair the functionality of platelets. The Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib inhibits the aggregation of platelets in blood by interfering with the signals responsible for activation. Platelet transfusion plays an important role in patients with ibrutinab-associated bleeding. Decisions on the use of platelet transfusion in this case is however dependent on individual blood count as well as the severity of the bleeding.

7. Used in patients with live diseases and DIC

Patients with liver disease and DIC have procoagulant and anticoagulant defects as well as thrombocytopenia indications, and are at risk of thrombosis and bleeding. Platelet transfusion is therefore, justified in such patients with serious bleeding, or those who are at a high risk of bleeding.

8. Leukaemia and chemotherapy

Patients with leukaemia, along with those being treated with cytotoxic chemotherapy and hematopoietic cell transplant (HCT), have a suppressed bone marrow which cannot produce enough platelets. Prophylactic transfusion is used in these settings.

9. Prevention of spontaneous bleeding

Prophylactic transfusion is useful in preventing spontaneous bleeding especially in patients at high risk of blood loss. The threshold for this prophylactic transfusion differs depending on the patient degree of blood loss and the clinical scenario.

10. Preparation for an invasive procedure

Platelets are transfused when preparing for an invasive procedure in cases where the level of thrombocytopenia is severe and the risk of bleeding is deemed high. Data used to determine the bleeding risk comes from retrospective studies involving patients that are afebrile and suffer thrombocytopenia but not coagulopathy. This is a preventive measure to avoid the effects of severe blood loss that the patient may be exposed to, due to the procedure.

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