Can a Platelet Transfusion cause a Stroke ?

Blee O'Myacin, BSN, RN · Apr 23, 2006

I've only done heme/onc, so when platelets are low, we transfuse. Our usual protocol is to transfuse at 20,000, unless there is active bleeding, then we'd like to keep them over 50,000.

He needs to get public assistance (medicaid) and get to a hematologist.

TazziRN, RN · Apr 23, 2006

Sounds like he got turfed right out the door. Poor guy. Do you have any contact with him? Would he qualify for public assistance?

soliant12 · Apr 23, 2006

There is definitely more to this story. Why would they keep him for three days and not give him platelets? This is not turfing since the patient was an inpatient for several days. I believe the OP is not getting the correct story.

jmgrn65, RN · Apr 23, 2006

I agree that there is more to the story, we have given platelets to a pt that had a count of 9 yes it really was that low. There has to be something else because what would keep his platelets from dropping that alone could kill him. I don't understand.

TazziRN, RN · Apr 23, 2006

Sorry, I missed the part about him being admitted. I thought he was sent out from the ER.

ICRN2008, BSN, RN · Apr 23, 2006

They told him that his platelets were too low to give him a Platelet transfusion. (Am I missing something here? Isn't that the reason you would transfuse the platelets???)
I'm still amazed that they sent him home with a Critical Platelet count.

It is possible that the physician meant that it would be inadvisable to transfuse platelets if he/she didn't know the cause of your friend's thrombocytopenia. I am just speculating, however, and your friend should seek clarification if he does not understand why he was discharged. It is important to remember that there are many serious risks associated with platelet transfusions, the most common one being infection.

By the way, at my institution a 30,000 platelet count would be considered low but not critical. That being said, your friend should see a physician as soon as possible to find the cause of his GI bleed.

EricJRN, MSN, RN · Apr 23, 2006

I've only done heme/onc, so when platelets are low, we transfuse. Our usual protocol is to transfuse at 20,000, unless there is active bleeding, then we'd like to keep them over 50,000.

This was the protocol at my last hospital, where I worked in the blood bank. If it weren't for the bleeding, I would say this pt's platelet count was too HIGH for transfusion.

It sounds scary if you haven't worked in a hem/onc setting much, but patients do commonly walk around, even as outpatients, with 30K platelet counts. They are on bleeding precautions of course, such as avoiding the use of safety razors.

Undecided7 · Apr 23, 2006

Maybe introducing that many platelets all at once would have caused clotting??? I do know they are VERY expensive, like $1000 a bag in my area, but I've had homeless people get them. Many docs are afraid of lawsuits because these patients need money, they can't pay the bill, but if they win- to doctor and hospital pay them! If he was really worried about being discharged maybe he should contact a doctor, the state welfare office, and a lawyer.

Hoozdo, ADN · Apr 24, 2006

I know someone who has 30,000 Platelets (Critical). He doesn't have Medical coverage.
He went to the hospital because he started bleeding from both ends. They admitted him for a couple of days, gave him some fluids & sent him home. They told him that they wouldn't give him a Platelet transfusion because he could get a Stroke from it. Is this true?
They told him that his platelets were too low to give him a Platelet transfusion. (Am I missing something here? Isn't that the reason you would transfuse the platelets???)
What are the chances of him stroking out if he would receive a PLT transfusion? Does anyone have any idea? He thinks they were BS'ing him because he doesn't have medical coverage.
I'm still amazed that they sent him home with a Critical Platelet count.
I hope that I will get some responses to this post. PLEASE respond.
Thank you very much.

Transfused platelets have a very short life span....only 3 or 4 days. You would want to transfuse platelets for procedures such as surgery or liver biopsies in a person with thrombocytopenia. One must fix the cause of the thrombocytopenia. In other words, a transfusion of platelets is just a quick fix - not a long term treatment option.

As an earlier poster mentioned, 30,000 is not a REALLY CRITICAL value. It is not a good value - but only really critical if you happen to get in a car accident or cut yourself deeply.

Best of luck to your friend.

caroladybelle, BSN, RN · Apr 24, 2006

While a platelet count of 30K is low, and considered critical on some units such as surgery or ortho, it is not critical on others such as hemo/onco. The goal levels on many onco units is 10K, or 20K if bleeding or 50K if an invasive procedure is planned.

As a general rule, expense of platelets in not an issue. I know of few MDs that base transfusion decisions on expense.

Scarcity of platelets can be an issue as well as refractory issues. While platelets generally do not require as close typing as PRBCs, occasionally patients (especially those that have had frequent transfusions, especially if in the 1980s or earlier) become refractory and require HLA matched products and those can be hard to come by. Patients that are refractory - you can transfuse them with platelets and it will actually drop the count or not increment adequately - their bodies will actually be mobilized to destroy platelets by the transfusion. This is why we limit transfusions to hemo/onco patients as many will become sensitized/refractory.

Many MDs will want to know the cause of the thrombocytopenia as soon as possible. If the patient has ITP or TTP, or is refractory, occasionally they will want HLA matched products, or to give IVIG, or high dose steriods....to attack the problem at its' source rather than randomly transfuse. In some cases, they will plasmapherese (dialyze, replacing the plasma to get rid of antibodies that might destroy platelets) the patient, in efforts to reverse the thrombocytopenia.

As to it causing a stroke, that is not something that I have seen much. But there are also issues in hematology that may precipitate DIC. And Hemos tend to base their treatment of DIC, as to what the patient is most a risk from, thus treatment varies.

Thus it is difficult to ascertain exactly what is wrong with the patient, and as to how the MDs is treating him. More information is needed.