A low MPV with a low platelet count in the bloodstream can develop secondary to specific medical or hereditary reasons. When this happens, the number of platelets in the blood is considerably lower than levels normally needed by the body. It increases the risk of bleeding considering that platelets are responsible in blood clot formation.
The condition may result to nosebleeds, heavier periods, bleeding gums, bruising, and/or other serious blood disorders. If the amount of platelets is considerably very low, the doctor is expected to 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. Platelet transfusion takes a duration that ranges between 15 to 30 minutes and can be performed at an outpatient clinic. Side effects are rare since all donated platelets are adequately tested for infections or viruses.
Platelet transfusions are common in the therapeutic treatment of patients with bleeding disorders that result from severe decrease in platelet production or development of abnormality in the functioning of platelets. A transfusion may be advised when the platelet count is lower than 50 x 109 /L such as in the cases of diffuse microvascular bleeding.
Platelets must be given as a prophylaxis in patients with very low platelet counts, or individuals experiencing a rapidly falling count. These are platelet counts less than 10 x 109/L common in patients with cancer, chemotherapy, or bone marrow failure in the absence of risk factors against transfusion; or less than 20 x 109/L in bone marrow failure without additional risk factors such as fever, antibiotics, or history of systemic hemostatic failure.
It can also be performed with the primary purpose of maintaining a count more than 50 x 109 /L during surgical procedures, as well as more than 100 x 109 /L in surgeries with higher risk of bleeding such as ocular procedures and neurosurgery.
The number of alternatives to platelet transfusion is limited, especially in the acute treatment of bleeding associated with thrombocytopenia. Long-term alternatives such as discontinuation in the use of drugs that affect platelet function, use of medicinal and diet strategies to increase platelet production, and treatment of underlying conditions may be considered by your doctor to reduce the need for platelet transfusion.
Platelet transfusion is very important to patients with a low platelet count. The procedure may also be used in the treatment of patients with bleeding disorders who experiences increased platelet consumption or dilutional thrombocytopenia. However, it has been found that the transfusion can be ineffective in patients with rapid platelet destruction.
1. Replacement of blood platelets lost during surgery or trauma
Patients displaying 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.
A patient transfused with six units of red blood cells will also receive 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. Therefore, platelet transfusion will play an important role in the replacement of platelets lost in the bloodstream with the cardiopulmonary bypass setting.
3. Lifesaving in patients with thrombocytopenia
Platelet transfusion has proven to be lifesaving in bleeding patients with thrombocytopenia (reduced platelets).
The procedure is performed in patients losing blood having 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 is also helpful when thrombocytopenic patients need to undergo 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 due to bone marrow suppression.
Individuals with acute promyelocytic leukemia (APL) are known to have a coexisting coagulopathy, needing a platelet transfusion threshold of 30,000 to 50,000/microL in these patients. Higher thresholds are used in patients who are known to be febrile or septic.
- Lise J Estcourt, Simon Stanworth, Carolyn Doree, Marialena Trivella, Sally Hopewell, Patricia Blanco, & Michael F Murphy (2015). Different doses of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation.
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 provided transfusions due to bleeding and invasive procedures.
Platelets transfusion needs not to be withheld in patients with the above conditions for fear of increasing the risk of thrombosis but the association remains.
6. Used in patients under medications that impair platelet function
Some medications impair the functionality of platelets. For example, the Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib inhibits the aggregation of platelets in the blood by interfering with the signals responsible for activation.
Therefore, platelet transfusion will play an important role in patients with ibrutinab-associated bleeding. Decisions on the use of platelet transfusion in this case is dependent on individual blood count as well as the severity of the bleeding.
- Alexander P. Bye, Amanda J. Unsworth, Michael J. Desborough, Catherine A. T. Hildyard, Niamh Appleby, David Bruce, Neline Kriek, Sophie H. Nock, Tanya Sage, Craig E. Hughes, & Jonathan M. Gibbins (2017). Severe platelet dysfunction in NHL patients receiving ibrutinib is absent in patients receiving acalabrutinib.
7. Used in patients with liver diseases and DIC
Patients with liver disease and disseminated intravascular coagulation (DIC) have procoagulant and anticoagulant defects as well as thrombocytopenia indications, making them at risk of thrombosis and bleeding.
Platelet transfusion is justified in such patients with serious bleeding episodes, or those who are at a high risk of bleeding.
8. Leukemia and chemotherapy
Patients with leukemia, along with individuals being treated with cytotoxic chemotherapy and hematopoietic cell transplant (HCT), have a suppressed bone marrow resulting to insufficient production of platelets. Prophylactic transfusion is used in these settings.
- Christopher Pleyer, MD, Amber Afzal, MD, William Shomali, MD, Paul Elson, PhD, Jia Xuefei, Suzanne Bakdash, MD MPH, Anjali S. Advani, MD, Aaron T. Gerds, MD MS, Hetty E. Carraway, MD MBA, Matt Kalaycio, MD, Jaroslaw P. Maciejewski, MD PhD, Mikkael A. Sekeres, MD MS, & Sudipto Mukherjee, MD PhD (2015). Impact of Red Blood Cell and Platelet Transfusions in Acute Myeloid Leukemia (AML) Patients Undergoing Remission Induction Chemotherapy.
- Charles A. Schiffer, Kari Bohlke, Meghan Delaney, Heather Hume, Anthony J. Magdalinski, Jeffrey J. McCullough, James L. Omel, John M. Rainey, Paolo Rebulla, Scott D. Rowley, Michael B. Troner, & Kenneth C. Anderson (2017). Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Updates.
9. Prevention of spontaneous bleeding
Prophylactic transfusion is useful in preventing spontaneous bleeding especially in patients at a high risk of blood loss. The threshold for prophylactic transfusion differs depending on the patient’s degree of blood loss and the clinical scenario.
- Richard M. Kaufman, MD; Benjamin Djulbegovic, MD, PhD; Terry Gernsheimer, MD; Steven Kleinman, MD; Alan T. Tinmouth, MD; Kelley E. Capocelli, MD; Mark D. Cipolle, MD, PhD; Claudia S. Cohn, MD, PhD; Mark K. Fung, MD, PhD; Brenda J. Grossman, MD, MPH; Paul D. Mintz, MD; Barbara A. O’Malley, MD; Deborah A. Sesok-Pizzini, MD; Aryeh Shander, MD; Gary E. Stack, MD, PhD; Kathryn E. Webert, MD, MSc; Robert Weinstein, MD; Babu G. Welch, MD; Glenn J. Whitman, MD; Edward C. Wong, MD; & Aaron A.R. Tobian, MD, PhD (2015). Platelet Transfusion: A Clinical Practice Guideline From the AABB.
- Neil Blumberg, Joanna M Heal, & Gordon L Phillips (2010). Platelet transfusions: trigger, dose, benefits, and risks.
10. Preparation for an invasive procedure
Platelets transfusion is necessary when preparing for an invasive procedure in patients where the level of thrombocytopenia is severe and the risk of bleeding is deemed high.
Data used to determine the risk of bleeding comes from retrospective studies involving patients that are afebrile and suffering from thrombocytopenia but not coagulopathy. This is a preventive measure to avoid the effects of severe blood loss that the patient may be vulnerable to, due to the procedure.
- Adrian Newland, Roy Bentley, Anna Jakubowska, Howard Liebman, Joanna Lorens, Markus Peck-Radosavljevic, Vanessa Taieb, Akiyoshi Takami, Ryosuke Tateishi, & Zobair M. Younossi (2019). A systematic literature review on the use of platelet transfusions in patients with thrombocytopenia.
- Estcourt LJ, Malouf R, Doree C, Trivella M, Hopewell S, & Birchall J (2018). Platelet transfusion before surgery for people with low platelet counts.
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