Platelet and Plasma Transfusion. Suzanne A. Arinsburg, DO Assistant Director Blood Bank and Transfusion Services Mount Sinai Hospital 4/13/2016

Size: px

Start display at page:

Download "Platelet and Plasma Transfusion. Suzanne A. Arinsburg, DO Assistant Director Blood Bank and Transfusion Services Mount Sinai Hospital 4/13/2016"

Kerry Malone
7 years ago
Views:

1 Platelet and Plasma Transfusion Suzanne A. Arinsburg, DO Assistant Director Blood Bank and Transfusion Services Mount Sinai Hospital 4/13/2016

2 Objectives Hemostasis Platelet transfusion Guidelines Evidence behind the guidelines Platelet refractoriness Plasma transfusion Guidelines Evidence behind the guidelines Risks of transfusion

3 Primary Hemostasis: Formation of the platelet plug

4 Primary Hemostasis: Formation of the platelet plug

5 Effect of Hematocrit: Decrease in hematocrit can lead to an increase in bleeding time

6 Secondary Hemostasis: Activation of the coagulation cascade

8 Stable Clot

10 Platelets Whole blood, buffy coat or platelet rich plasma derived platelets Suspended in ml of plasma or platelet additive solution May be leukoreduced Single donor apheresis platelets Stored between C Shelf life 5 days Risk of bacterial contamination TRALI mitigation

11 Platelets Life span approximately 10 days Platelets form from megakaryocyte blebs 40% in the spleen 60% circulate Normal counts are /microliter 7-10x10 3 are consumed daily

12 Platelet Transfusion Expected increase in platelet count 30,000-60,000/microliter Out of group transfusions Try to match for RhD but not required

19 For adults: one apheresis platelet, equivalent to 6-8 units of platelets, is indicated: Platelet count 10,000/uL as prophylaxis against spontaneous bleeding in all patients including: Therapy-induced hypoproliferative thrombocytopenia Bone marrow / stem cell transplant patients Platelet count 20,000/uL and Minor bleeding, heparin, fever, sepsis, coagulopathy, anatomic lesion at risk of bleeding Prior to elective catheter placement* Heme-Onc inpatients about to be discharged home or outpatients who are platelet transfusiondependent Platelet count 50,000/uL and Patient with active bleeding Invasive procedure (recent, in-progress or planned) Endoscopic procedures* Lumbar puncture Platelet Count 80,000/ ul Epidural anesthesia Platelet count 100,000/uL with Bleeding in a closed anatomical space (e.g., CNS, ocular) Neurosurgical patients Bleeding after cardiopulmonary bypass Patients on extracorporeal membrane oxygenation (ECMO) In the setting of massive transfusion, without platelet count In the setting of known platelet dysfunction, with a normal or elevated platelet count Other (specify):

20 Contraindications to Platelet Transfusion Absolute contraindications in the absence of significant or life threatening bleeding Thrombotic thrombocytopenic purpura Heparin induced thrombocytopenia Relative contraindications in the absence of significant or life threatening bleeding Immune thrombocytopenia

21 Platelet Refractoriness Immune versus non immune causes Anti-human platelet antigen antibodies and anti-hla Class I antibodies Check 1 hour post platelet count Calculate corrected count increment CCI = Post-Transfusion Platelet Increment (10 9 /l) x Body Surface Area (m2) Transfused Platelets > 7500 nonimmune causes <7500 immune causes

23 Platelet Antibody Testing

24 Platelet Antibody Testing

25 Interpretation Chloroquine destroys anti-hla reactivity. If you have a positive reaction, add chloroquine. If the reaction is still positive and the reactivity is the same, anti-platelet antibodies are present. If the reaction is still positive and the reactivity is decreased, both anti-platelet and anti-hla antibodies are present. If the reaction becomes negative, only anti-hla antibodies are present.

26 Management Crossmatched platelets HLA matched platelets

28 Nonimmune Causes of Platelet Refractoriness Fever Sepsis Antibiotics Drugs Consumption Bleeding Hypersplenism

29 Plasma Collected from whole blood or apheresis Frozen and stored at `18 C or colder for up to 12 months FFP Frozen within 6 or 8 hours of collection Normal levels of all clotting factors, antithrombin, and ADAMTS13 PF24 Thawed plasma FFP or PF24 thawed and held at 1-6 C for up to 5 days Normal levels of fibrinogen and thrombin, other factor levels are decreased Thawed in water bath at C Shelf life of 24 hours at 1-6 C AABB interventions to minimize risk of TRALI Collected from males, nulliparous females, or HLA antibody negative females

32 Relationship between INR and % Coagulation Factors

33 Plasma Transfusion Abnormal coagulation tests do not predict bleeding Normal coagulation factor activity between % About 30% activity needed for hemostasis with a single factor deficiency About 40% activity needed for hemostasis with multiple factor deficiencies Usual dose is ml/kg expected to increase factor levels about 20% Must consider half-life of the deficient factor that you are correcting ABO group matching

44 Risks of Platelet and Plasma Transfusion

48 Questions???

SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES

SARASOTA MEMORIAL HOSPITAL BLOOD COMPONENT CRITERIA AND INDICATIONS SCREENING GUIDELINES TABLE OF CONTENTS SUBJECT PAGE ADULT CRITERIA Red Blood Cells/Autologous 2 Washed Red Blood Cells 2 Cryoprecipitate