Bsh Platelet Transfusion Guidelines 2016 Flashcards
What would be advised for prophylactic Transfusion in those with reversible bone marrow failure where recovery expected?
-give if WHO bleeding score 0/1 to maintain plt >10
-usually only one dose
-consider not giving prophylactic platelets to those who have had an auto SCT if no bleeding
-increase threshold to 20 in those with additional risk factors
What would be advised for prophylactic Transfusion in those with chronic bone marrow failure where recovery isn’t expected?
-use a no prophylactic platelet strategy for asymptomatic
-give prophylactic transfusion to those receiving intensive chemo
-individual management for those with chronic WHO grade 2 bleeding, consider twice weekly prophylaxis
General recommendations for transfusion prior to procedure or surgery
-use a procedure/equipment associated with lowest bleeding risk
-apply local measures like compression
Do not give platelets routinely prior to these procedures
BMAT
PICC insertion
Traction removal of CVC
Cataract surgery
Platelet threshold for CVC insertion
> 20
Platelet threshold for LP
> 40
Platelet threshold for insertion/removal of epidural
> 80
Platelet threshold for major survery
> 50
Platelet threshold for neurosurgery/ophthalmic surgery involving posterior eye
> 100
Platelet threshold for percutaneous liver biopsy
> 50, otherwise aim for transjugular
Prior to renal biopsy which risk factors should be corrected?
Anaemia
Uraemia
If biopsy is urgent consider DDAVP or oestrogen
Avoid platelet infusion as acquired dysfunction and potential alloimmunisation
Recommendation for therapeutic platelets in severe bleeding
> 50
Recommendation for therapeutic platelets in mutli trauma, traumatic brain injury or spontaneous ICH
> 100
Recommendation for therapeutic platelets in non severe/lifethreatening bleeding
Consider if plt <30
Management of bleeding in glanzmann
First-line treatment/prevention: rFVIIa
-consider HLA matched platelets if this is unsuccessful/high risk
Management of congenital platelet disorders with bleeding
- txa and desmopressin
- consider platelets if severe or ineffective
Should platelets be used pre procedure if APT not stopped?
No
Measures taken for bleeding in those on aspirin or p2y12 antagonists or glycoprotein iia/iiib inhibitors
-general haemostatic measures
-drug cessation where able
-reversal of coprescribed AC
-TXA considered with risk/benefit analysis
-platelet transfusion in critical bleeding
Platelet transfusion in itp
-only prior to procedure when other treatment failed or serious bleeding
-consider in conjunction with ivig
Ptp treatment
Ivig
Contraindication to platelets
MAHA unless critical bleeding
Risks of platelet transfusion
-strategy to maximise ABO compatible platelets
-acceptable to use ABO incompatible platelets to reduce wastage if negative for high titre haemagglutinins and non group O
Who should receive D -ve platelets (positive can be given if -ve not available)
-D -ve women of child bearing age should receive D-ve
- D-ve boys <18yrs
- those with anti D ab
- transfusion dependent adults
What to use in non mild allergies
Platelets in PAS. If severe use washed though
Platelet refractoriness management
-ABO matched
-no hla matched platelets for non-immune causes
-hpa selected if antibodies and refractory to hla matched
Txa admin in trauma patients?
Yes, administer early
When should txa be used in surgery?
If ebl estimated >500ml and no contraindications
Should you consider txa in conjunction/as alternative to platelets in chronic BMF
Yes
