Hi, do we have any blood bankers here from CHOP or BCH or elsewhere who deal with pediatric platelet transfusions?  Our small little community hospital will be supporting a 9 year old child who is now on Hospice.  I can obtain the necessary products (irradiated, etc), but I have a question about the platelet transfusion.

She is 24 Kg., the usual dose is 4 single donor platelets, sometimes concentrated to remove the plasma, we will be giving her pheresis platelets and we have no method to concentrate or remove the plasma.  No ISBT labeling, no Pooling equipment, no centrifuge for donor packs, etc.

Is this going to be a problem?  I did speak with the Fellow in Bone Marrow Transplant from her Pediatric Medical Center and she did not seem to think that fluid was a problem (patient also has nutritional issues and needs fluid support).

Do you think that the Pediatric medical center (about 90 minutes away by car) would be able to provide me with the concentrated platelet product?

 

I know I am asking a lot, but I want to figure out if I am getting the best products for this patient.

 

Thanks you.

 

M

SDP are suspended on 100-500 ml plasma and additive solutions. Giving 4 SDP can cause volume overload. Pediatric medical center with centrifuge should be able to provide you with volume reduced platelets. 

Did you mean four single donor apheresis platelets (equivalent to an old "six pack")?  Most of our peds oncologists dose apheresis SDP in kids @ 10-15 mL/kilo.  At 24 kilos, your patient would get one irradiated apheresis SDP at our institution (most of ours are around 270mL with a plt count of at least 3.0).  If volume really isn't an issue for your patient, that would be fairly simple.  If they really plan to use four single donor apheresis platelets, I would agree that they would need to reduce the volume.  That would really be a big dose, though.  Our adult oncology patients typically only get one with a plt<10,000

At Nationwide Children's Hospital (Col, OH), we use single donor apheresis platelets at a standard dose of 5ml/kg.  Sometimes they will order a 10ml/kg dose if they need a larger bump or for the oncology outpatients.  So, for your 24kg patient we would usually split that apheresis unit (about half of a unit).  Since you can't aliquot the product yourself, I would get the Medical Director involved in the decision to give either the whole unit or a specific volume of that apheresis unit.  They can always give the ordered volume and discard the remainder.

If we have limited availability of plateletpheresis, we would make the switch to a pre-pooled platelet product (4 donors).  The total volume should be very similar to one plateletpheresis, so you could handle that volume exactly as I described above for the plateletpheresis.  We very rarely have to give a volume-reduced platelets here when given at that recommended 5-10ml/kg dose -just FYI.

Hope this helps,

Stephanie

Thank you everyone - when I said they were ordering 4, I am referring to the little tiny single packs that we used to pool about 20 years ago.  I plan to give her one pheresis pack from our blood supplier, which could be either full of plasma, or not - the sizes are so variable.  She is a B Neg to top it off, so what I get will be what they have with no choice to pick the smaller ones.

Does anyone know if you volume reduce the platelet product does it get a new ISBT label?  I would have to build that product into my LIS system also.

Hopefully she will tolerate the single pheresis, and hopefully it will be on the small side.

Yes, volume reduced get a new ISBT product code. Here is one example

E3047  Apheresis PLATELETS|ACD-A/XX/20-24C|Irradiated|ResLeu:<5E6|Plasma reduced

Ask your blood supplier for the codes they use.

I thought you meant random donor plts and not single donor (apheresis).