Volume reduction of platelets

[C Riley]

At our institution we volume reduce platelets for our pediatric patients, averaging about 10 per week. Currently we use a Sorvall RC3C floor model to accomplish this and are interested in a replacement. What are other insitutions using. Does anyone have any experience with the Rotanta 460 or 460S made by Hettich. It is a table top model.

[sgoertzen]

We have a table top MSE, Mistral 3000i. It is quite old (>15 years) but works well. It may no longer be available for purchase.

What surprises me is the number of volume reduced platelets you prepare. I supervise the transfusion service at a 300 bed pediatric hospital with a full NICU, PICU, heme/onc department and cardiovascular surgery department. We transfuse approx. 100-120 platelet transfusions per month, but we only volume reduce platelets maybe 10 times per year. We really try to discourage physicians from ordering spun platelets and most are happy with giving small volume aliquots made from the leukoreduced plateletpheresis units. I've copied (below) the "principle" section from our procedure for volume reducing platelets:

PRINCIPLE

Random platelets or plateletpheresis must sometimes be spun in order to reduce the total plasma volume of the product. There are only three conditions where spun platelets are warranted:

1. No ABO compatible platelet units are available for a patient weighing less than 45 kg. It is acceptable to give ABO incompatible platelets unspun if the patient weights over 45 kg. DO NOT CALL PATHOLOGIST if you must spin platelets due to ABO incompatibility.

2. Patient in fluid overload due to heart or renal failure. Even in these conditions, it is better to divide the product into smaller volumes using the sterile connecting device than to spin the product.

3. Patient has repeated severe allergic/anaphylactic reaction to plasma proteins in platelet products (even after pre-medication with Benadryl). Take these platelets down as “dry” as possible and add back 25 mL of Lactated Ringers prior to 60 minute rest incubation.

• QUESTION ALL ORDERS FOR SPUN PLATELETS

The use of spun (volume reduced) platelets is strongly discouraged and REQUIRES APPROVAL BY A PATHOLOGIST.

[Kent]

We use a IEC (now Thermo Electron) GP8 table top centrifuge. It works well although the caps for the centrifuge cups have clips that are inconvenient.

We also try to discourage the use of volume reduced platelets. Platelet concentrates are already concentrated! Further concentration is likely to lead to clumping and decreased effectiveness of the transfused platelets. Most of the neonatal platelet transfusions in our institution are not volume reduced. The exception is for ECMO patients who need a rapid infusion of platelets and cannot tolerate any extra volume.