Transfusion not given

[amandagracen]

I had a possible patient care question.

If a patient was admitted with a platelet count

[Penelope_Pitstop, BSN, RN]

Platelet Transfusion: A Clinical Practice Guideline From the AABBPlatelet Transfusion: A Clinical Practice Guideline From the AABB | Annals of Internal Medicine

Is the patient going to have some kind of invasive procedure? If not, holding off on the tranfusion is okay.

[KelRN215, BSN, RN]

In general, we don't transfuse platelets until platelet count

[CelticGoddess, BSN, RN]

I work Onc. We frequently have patients who have low platelets. If the pts platelets drop below 10,000, we transfuse. If above, it's watchful waiting. All invasive procedures are held until it is safe to do so. These pts typically have PICCs or ports so we minimize sticks for labs.

If a pt with a low platelet count starts to bleed, there is a bleeding protocol for transfusion. I've seen a patient transfused with bleeding protocol 1x.

[KatieMI, BSN, MSN, RN]

The short answer is "no".

Platelets have half life of about 7 days normally, and much less if they are transfused. They are enormously expensive. And they, being pooled from several donors, can initiate immune responce, which leads to patient being sensitized to blood antigens. It makes transfusions of everything (and transplant search, if needed) really complicated.

A person who takes ASA and Plavix full dose and has, say, ESRD/HD, has his platelets almost non-functional whatever the number might be, and everything we have to teach him is to try not to cut himself, no IM injections, and let it all be known to any health provider the first thing after you say "hi". These people live almost normal life, with platelet activity roughly equivalent of number 25000. When the numbers become extreme low in acute care (where these people are poked every 3 hours or so, have procedures and lines and higher risk of fall, then transfusions may be justified.

[amandagracen]

Awesome. Thanks for the info. In this case patient had no medical history or meds and ended up with pulmonary hemorrhage after no platelets ever given even when less than 10,000. Just was wondering about care given and what to watch for/ push for with mds.

[MunoRN, RN]

Many patients have thrombocytopenia that is refractory to transfusions; they'll quickly "chew up" additional platelets above their baseline amount. Frequent prophylactic transfusions in these patients are more likely to cause harm due to transfusion reaction risks than they are to be beneficial and generally should be limited to specific instances where increased platelet counts are particularly necessary for a short period of time, such as for an invasive procedure, surgery, or active GIB.

One of the odd things about pulmonary/alveolar hemorrhage is that they aren't related to platelet counts, so even though they may seem related, they probably weren't.

Platelets in pulmonary vascular physiology and pathology