Neo/Peds Platelet Transfusions

[mawomack]

Apparently we are the only hospital in Central Florida that is still giving reduced volume random donor platelets to our neo/peds patients. With the 26th Standards we would have to institute pH testing upon issue. What are others doing for neo/peds platelet transfusions? splitting pheresis units? Do you have a volume or calculation that is being used. Thanks for your advise.

[adiescast]

We split pheresis units with a sterile docking device.

[mawomack]

how do you determine the dose/amount to give? based on patient weight? platelet count? standardize volume? of sterile doc'ed pheresis.

[shelleyk482]

We sterile dock syringes to a plateletpheresis and pull out the amount ordered by the physician. I assume the physicians are determining dosage using body weight. The recommended dosage is 5-10 mL/kg (Pediatric Transfusion: A Physician's Handbook).

[adiescast]

how do you determine the dose/amount to give? based on patient weight? platelet count? standardize volume? of sterile doc'ed pheresis.

The doctor orders by volume.

[Eagle Eye]

same here...we aliquot physician requested volume in pediatric syringe using sterile doc.

[MAGNUM]

Same as most others, we sterile dock the syringe setups onto the plt unit and aliquot the volume the physician has requested.

[martha]

How do you determine the price for each aliquot of platelet pheresis? Do you charge for each aliquot?

Thanks

Martha

[adiescast]

Ah, now that is tricky. We estimated how many aliquots generally get used from a unit of pheresed platelets and divided the total by that number. Sometimes we get paid for more than the whole unit, sometimes we get paid for less. We try to get it to the point where is averages out.

[PaulSunV]

We sterile dock syringes to an apheresis platelet and pull out the amount ordered by the physician. The first aliquot is billed for the unit and unless there is a set of twins that need platelets that unit is reserved for the baby that was charged for it.

[Townsend]

We also use a sterile connection device and make either bag or syringe aliquots from plateletpheresis units. The standard dose we use is 5ml/kg, occasionally the physician will order 10ml/kg. More than a double-dose is usually approved by our TS Med Director first (unless the need is obvious - OR or massively bleeding pt). We have not filled a "volume-reduced" request in quite some time. Again, this would only be after approval from the Med Dir. We only go to random platelets when a specific type of plateletpheresis is not available.

We've created 3 different orders, transfuse plt syringe, transfuse plt bag, transfuse whole platelet. Each order has a price that is adjusted for the approx amount - syringe price about 1/4 of a whole apheresis unit, bag aliq equal to about 1/2 of an apheresis unit. It's not perfect, but we feel it is the best way to get our money's worth while being fair to the patient. There may also be some hospitals that bill by volume, which we do not do currently.

[lisakg]

Where in the 26th Standards does it require the pH at issue of the volume reduced random donor platelet?

[Abdulhameed Al-Attas]

We do the same as Mawomack but the Doctor is one who must determine the volume.

Also we extend the platelet pheresis (PRP) to two more days beyond their expiry date.

[adiescast]

Where in the 26th Standards does it require the pH at issue of the volume reduced random donor platelet?

It doesn't require the pH at issue, that I can see. The pH requirement is a sample from all batches made by the blood provider. 90% of the units sampled must have pH >=6.2 at the end of allowable storage. (Standards 5.7.5.17) I did not see anything specific about volume reduction.

[mwilde]

The medical director at Indiana Blood Center has researched this question with many articles and by talking with people in some of the larger institutions nationwide. The neonates will get a decent increment with a small volume from a pheresis platelet. The physician won't see the same increment he/she is used to, but the risk of bleeding is corrected. The manipulation involved in volume-reduction increases the risk of contamination. Like many, I use a sterile connecting/docking device for a sterile weld.