Platelet Transfusion - An Overview

Introduction

When a person's platelet count is too low to control bleeding and clotting blood due to various medical conditions, a platelet transfusion is required. This type of transfusion is often required for people with medical conditions like leukemia, thrombocytopenia, and aplastic anemia, as well as for those who are undergoing chemotherapy or radiation therapy, medical procedures, surgery, or have suffered significant blood loss. The decision to undergo platelet transfusion is based on the individual's platelet count, underlying medical condition, and clinical symptoms.

What Is Platelet Transfusion?

Platelet transfusion is a medical intervention that involves the infusion of platelets from a donor's blood into a patient's bloodstream. This procedure is necessary when a patient has a low platelet count or platelet dysfunction, as platelets are crucial for blood clotting. The collected platelets are transfused to the patient in need.

What Are the Types of Platelet Transfusions?

Platelet transfusions can be categorized on the basis of the following:

• Based on Donor Source: Donor sources can either be from a single donor or multiple donors.

• Based on Processing Method: The processing method can be through filtration, irradiation, or pathogen inactivation to reduce risks.

• Based on the Recipient Characteristics: Recipient characteristics determine tailored transfusions, including platelet count, blood type, and transfusion reaction history. "Therapeutic" transfusions can treat low platelet counts, while "prophylactic" transfusions may occur before surgery. Platelet transfusions require regulation and consideration to ensure safety and efficacy.

What Are the Signs and Symptoms of Low Platelet Count?

The following symptoms may indicate low platelet count or platelet dysfunction:

• Easy or excessive bruising.

• Superficial bleeding like nosebleeds or bleeding gums.

• Small red or purple dots on the skin (petechiae).

• Prolonged bleeding from cuts or injuries.

• Heavy menstrual periods or abnormal vaginal bleeding.

• Blood in the urine or stool.

• Fatigue or weakness.

• Enlarged spleen.

It's important to note that these symptoms can also be associated with other medical conditions, and a consultation with a medical professional is necessary for an accurate diagnosis.

What Are the Indications of Platelet Transfusion?

Platelet transfusion may be necessary in the following cases:

• Thrombocytopenia is when the platelet count is below 10,000 to 20,000 per microliter or if there is active bleeding and the platelet count is below 50,000 per microliter.

• When there is significant bleeding or before an invasive procedure that carries a high risk of bleeding.

• Chemotherapy-induced thrombocytopenia, when cancer treatment causes low platelet counts and increases the risk of bleeding.

• Hemorrhagic disorders, such as idiopathic thrombocytopenic purpura (ITP) and von Willebrand disease, where there is a bleeding disorder or a deficiency of von Willebrand factor.

• Platelet function defects, such as Glanzmann thrombasthenia or Bernard-Soulier syndrome, where there is a defect in platelet function.

• Prophylaxis, in certain high-risk situations such as during massive transfusion, where platelet transfusion may be given as prophylaxis to prevent bleeding.

What Are the Contraindications of Platelet Transfusion?

The potential contraindications to platelet transfusion include:

• Heparin-induced thrombocytopenia (HIT).

• Thrombotic thrombocytopenic purpura (TTP).

• Disseminated intravascular coagulation (DIC).

• ABO incompatibility.

• Hypersensitivity to platelet transfusions or blood products.

• Febrile nonhemolytic reactions.

• Fluid overload in patients with heart or kidney disease,

• Infections in patients with active infections, or who are at risk for certain infections.

What Is the Equipment Necessary for the Platelet Transfusion?

The equipment needed for a platelet transfusion includes:

• A platelet concentrate bag.

• A blood tubing set with a filter.

• An infusion pump or gravity drip stand,

• A sterile connecting device.

• A needle or catheter for insertion into the patient's vein.

• Blood pressure cuff and monitoring equipment.

• Adhesive tape.

• Dressing to secure the needle or catheter site.

What Is the Procedure for Platelet Transfusion?

Platelet transfusion typically involves several steps including the following:

• Ordering and verifying the correct blood product,

• Verifying the patient's identity and blood type,

• Obtaining informed consent.

• Inspecting the platelet product.

• Infusing the platelets through a sterile transfusion set within 30 minutes of removal from storage.

• Monitoring the patient for adverse reactions.

It is crucial to adhere to established protocols and guidelines for platelet transfusion to ensure the safety and effectiveness of the procedure.

What Are the Complications of Platelet Transfusion?

Correct, platelet transfusions have the potential to cause several complications, including the following:

• Allergic Reactions: Platelet transfusions can elicit varying degrees of allergic reactions in patients, ranging from mild itching to a potentially fatal response.

• Transfusion-Related Acute Lung Injury: TRALI is an infrequent but severe complication that may result in acute respiratory distress, fever, and hypotension in patients who have received a blood transfusion.

• Transmission of Infections: While uncommon, platelet transfusions have the potential to transmit infectious agents, including viruses, bacteria, and parasites.

• Transfusion-associated Circulatory Overload: TACO is a condition that arises when a patient receives an excessive amount of fluid through a transfusion, causing fluid accumulation, dyspnea, and heart dysfunction.

• Platelet Refractoriness: Platelet refractoriness refers to a condition where platelet transfusions do not produce the desired response in patients, which may be caused by immune-mediated platelet destruction or certain medications taken by the patient.

• Transmission of Abo Incompatible Platelets: When platelets that are incompatible with a patient's blood type are transfused, it can trigger an immune response that causes the destruction of red blood cells and possible organ damage.

• The Development of Antibodies: Frequent transfusions can result in the production of antibodies, which may reduce the effectiveness of future transfusions or even cause harm to the patient.

It is important to monitor patients for any adverse reactions during and after the transfusion and to follow established protocols and guidelines to minimize these risks.

Conclusion

It is important to consider the potential risks and benefits of any medical procedure, including platelet transfusion, and to make informed decisions based on the patient's individual medical situation. The decision to perform a platelet transfusion should be made by a healthcare professional based on the patient's medical condition and the potential benefits and risks of the procedure. Platelet transfusion is generally safe and effective, but it can carry risks, such as allergic reactions and infections. The procedure is commonly used to prevent bleeding or to stop bleeding that has already begun in patients with low platelet counts.