Bsh Platelet Transfusion Guidelines 2016

Question 1

What would be advised for prophylactic Transfusion in those with reversible bone marrow failure where recovery expected?

Answer 1

-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

Question 2

What would be advised for prophylactic Transfusion in those with chronic bone marrow failure where recovery isn’t expected?

Answer 2

-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

Question 3

General recommendations for transfusion prior to procedure or surgery

Answer 3

-use a procedure/equipment associated with lowest bleeding risk
-apply local measures like compression

Question 4

Do not give platelets routinely prior to these procedures

Answer 4

BMAT
PICC insertion
Traction removal of CVC
Cataract surgery

Question 5

Platelet threshold for CVC insertion

Answer 5

> 20

Question 6

Platelet threshold for LP

Answer 6

> 40

Question 7

Platelet threshold for insertion/removal of epidural

Answer 7

> 80

Question 8

Platelet threshold for major survery

Answer 8

> 50

Question 9

Platelet threshold for neurosurgery/ophthalmic surgery involving posterior eye

Answer 9

> 100

Question 10

Platelet threshold for percutaneous liver biopsy

Answer 10

> 50, otherwise aim for transjugular

Question 11

Prior to renal biopsy which risk factors should be corrected?

Answer 11

Anaemia
Uraemia
If biopsy is urgent consider DDAVP or oestrogen
Avoid platelet infusion as acquired dysfunction and potential alloimmunisation

Question 12

Recommendation for therapeutic platelets in severe bleeding

Answer 12

> 50

Question 13

Recommendation for therapeutic platelets in mutli trauma, traumatic brain injury or spontaneous ICH

Answer 13

> 100

Question 14

Recommendation for therapeutic platelets in non severe/lifethreatening bleeding

Answer 14

Consider if plt <30

Question 15

Management of bleeding in glanzmann

Answer 15

First-line treatment/prevention: rFVIIa
-consider HLA matched platelets if this is unsuccessful/high risk

Question 16

Management of congenital platelet disorders with bleeding

Answer 16

• txa and desmopressin
• consider platelets if severe or ineffective

Question 17

Should platelets be used pre procedure if APT not stopped?

Answer 17

No

Question 18

Measures taken for bleeding in those on aspirin or p2y12 antagonists or glycoprotein iia/iiib inhibitors

Answer 18

-general haemostatic measures
-drug cessation where able
-reversal of coprescribed AC
-TXA considered with risk/benefit analysis
-platelet transfusion in critical bleeding

Question 19

Platelet transfusion in itp

Answer 19

-only prior to procedure when other treatment failed or serious bleeding
-consider in conjunction with ivig

Question 20

Ptp treatment

Answer 20

Ivig

Question 21

Contraindication to platelets

Answer 21

MAHA unless critical bleeding

Question 22

Risks of platelet transfusion

Answer 22

-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

Question 23

Who should receive D -ve platelets (positive can be given if -ve not available)

Answer 23

-D -ve women of child bearing age should receive D-ve
- D-ve boys <18yrs
- those with anti D ab
- transfusion dependent adults

Question 24

What to use in non mild allergies

Answer 24

Platelets in PAS. If severe use washed though

Question 25

Platelet refractoriness management

Answer 25

-ABO matched
-no hla matched platelets for non-immune causes
-hpa selected if antibodies and refractory to hla matched

Question 26

Txa admin in trauma patients?

Answer 26

Yes, administer early

Question 27

When should txa be used in surgery?

Answer 27

If ebl estimated >500ml and no contraindications

Question 28

Should you consider txa in conjunction/as alternative to platelets in chronic BMF

Answer 28

Yes