Platelet Transfusion Rate

[nkochrn, RN]

I'm looking for some good resources on platelet administration, I think our policy needs to be revised, so I'd like to have some good resources to back up any suggestions.

Our current policy states to give over 10 minutes. We have a pt. that has been getting frequent transfusions and had a reaction when it was infused over 10 minutes. There has been lots of debate over how rapidly they should be infused. I believe he's been getting them at 400 ml/hr.

[silentRN]

just wide open. Not really a policy for rate, but we have a policy for how long after you receive the blood product from blood bank that the blood must be transfused which is generally 4 hours because of the risk of infection. A policy also to monitor the patient for reaction. How fast you dump it in is up to you.

[Flying ICU RN]

Try this... Platelet Transfusion Guidelines.

[jlcole45]

Usually as fast as you can give them. If they need them they need them right away.

[BluegrassRN]

We give them wide open; I haven't given platelets for a while, but I'm not even sure the tubing can run through a pump. It seems like platelets comes with its own short little tubing that can't run through a pump, at our facility at least. I may be confusing it with FFP, though. I seem to only get the ones who need PRBCs. I haven't given FFP or platelets in forever.

[catshowlady]

My facility's policy is 10mL/min, or 600mL/hr. Does your facility have an actual policy?

:paw:

[Daliadreamer]

Usually we just dump it in, unless they have CHF or fluid overload, then it's a slow drip with frequent monitoring. Like an earlier post stated, if the patient needs platelets, they need them ASAP.

[grandmawrinkle]

"Platelets, more often than red blood cells, are the cause of febrile nonhemolytic transfusion reaction because they are stored at room temperature, which is conducive to leukocyte activation and cytokine accumulation." from CMAJ • July 17, 2007; 177 (2). doi:10.1503/cmaj.061106.

Platelets are higher risk for transfusion reaction than other types of blood products for the reason stated above. I think it is unlikely that the reaction you speak of had to do with the fact that you ran the platelets in quickly as that is the standard of care at most institutions to my knowledge. Patient should go through a transfusion workup like any other reaction so the blood bank can make recommendations for future transfusions.

[blondy2061h, MSN, RN]

We give them over a half hour. They run to gravity, so it can be hard to estimate. I'll usually give the first 15 minutes slower than speed them up if the patient is tolerating well. If the pt reacts, the plts aren't going to do them any good. I give plts pretty much daily.

[iluvivt, BSN, RN]

Before you make any changes to your nursing policy you need to check the AABB technical manual...your blood bank should have a current copy. Generally, platelets need to be infused rapidly(5ml/per min) b/c they start doing their job and clumping together like crazy in the bag. Some pts become desensitized to platelets especially after several transfusions of them. They develop platelet specific and HLA antibodies to them and this caused a febrile reaction. These types of pts need to have platelets that come from plateletphoresis (a single doner) and/or HLA matched donors. The pts reaction was probably not rate dependent...... he most likely had a reaction to the donors leukocytes..he probably had been getting random donor concentrates...right?? ..either way he now needs to be tested or receive HLA matched and or platletphoresis..does it cost more....YES I suspect it does but the problem only gets worse.once a pt is refractory to platelets ..they really have to switch to single donor