Fresh platelets for actively bleeding patients?

[Kathy]

Our ICU director says that she notices that actively bleeding patients have minimal post-transfusion platelet count increases with platelets that are nearing their expiration date compared with platelets that are fresher. She would like for us to issue fresher units to actively bleeding patients. Obviously, platelet inventory management is a huge problem and we like to have the best use of our inventory so I would like some proof to support her position before I would institute a policy that might increase our platelet wastage. Do any of you know of any studies that specifically deal with platelet refractoriness as a function of platelet storage time in actively bleeding patients?

[Liz]

"Platelet factors that were associated with improved platelet responses were giving ABO-compatible platelets, platelets stored for 48 hours or less, and giving large doses of platelets"

Article:

Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients.

Slichter SJ, Davis K, Enright H, Braine H, Gernsheimer T, Kao KJ, Kickler T, Lee E, McFarland J, McCullough J, Rodey G, Schiffer CA, Woodson R

Blood. 2005;105(10):4106.

[R1R2]

Our ICU director says that she notices that actively bleeding patients have minimal post-transfusion platelet count increases with platelets that are nearing their expiration date compared with platelets that are fresher. She would like for us to issue fresher units to actively bleeding patients. Obviously, platelet inventory management is a huge problem and we like to have the best use of our inventory so I would like some proof to support her position before I would institute a policy that might increase our platelet wastage. Do any of you know of any studies that specifically deal with platelet refractoriness as a function of platelet storage time in actively bleeding patients?

Can your ICU director provide you with data she collected? Did she look at the blood types issued and patient blood types? I have been asked for fresher platelets for oncology patients, never for actively bleeding patients.

[John C. Staley]

The key here is "Actively Bleeding"! As long as the patients are actively bleeding a lot of the platelets are being lost on the floor with the rest of the blood. The key to getting the platelet counts to go up is first, plug the hole, then give the platelets to seal it tight. I worked with a thoracic (sp?) surgeon who had hands like boxing gloves. He would do a by pass and pour platelets into the patient as if there was no end to the supply and then scream for more when we ran out. He figured that platelets should be able to plug up the holes he left that you could drive a truck through. Bottom line from my experience was that in these types of patients the rise in platelets had more to do with the ability of the surgeon than with the age of the platelets.

[carolyn swickard]

"Platelet factors that were associated with improved platelet responses were giving ABO-compatible platelets, platelets stored for 48 hours or less, and giving large doses of platelets"

Article:

Factors affecting posttransfusion platelet increments, platelet refractoriness, and platelet transfusion intervals in thrombocytopenic patients.

Slichter SJ, Davis K, Enright H, Braine H, Gernsheimer T, Kao KJ, Kickler T, Lee E, McFarland J, McCullough J, Rodey G, Schiffer CA, Woodson R

Blood. 2005;105(10):4106.

Wouldn't plts stored less than 48 hours still be untested with current bacterial detection methods - they don't even get labeled for 48 hours, right? Otherwise, good article - impossible to handle your plt inventory that way most of the time though. All we have to do is ask for type-specific or type-compatible to be told "none of those are available today".

[Eagle Eye]

fresh platelet!!!!!!!! my god we try not to entertain the idea of fresh RBC...and here you need to give fresh platelet...I would ask for the data...ask them to do some review for all the cases.

My medical director will not entertain these kind of demnad...not for bleeding patient.

for the patient who are refractory...once it's established based on CCI count and there is no other area of platelet consumption (usually our hematologist gets involvedat that level), my medical director will approve type specific/crossmatch compatible/HLA matched based on platelet antibody result...never fresh platelet!!

[Kathy]

My medical director doesn't like the idea either and said the same thing, which I agree with, and that is to give me proof that older platelets are not working for your patients. Only then would I start to investigate further...there are so many factors that play into this issue. Maybe it would be a good thing for the residents to research.