I need some help. We have a new neurosurgeon who is insisting that we keep 5 platelet pheresis products on-hand at all times for potential brain bleeds. To give you some background, we are a 350 bed hospital withOUT a trauma designation and who does not do solid organ transplant. Our platelet usage has been reduced by half in the past 2 years as blood loss during surgical procedures has been curtailed. I have been working very hard to cut down on platelet waste. In 2014, there were months when we wasted 8-12 units of platelets/month. We are about 3 hours from our blood supplier.

If there is anyone out there willing to share their protocol for patients with brain bleeds? I would be MOST appreciative! It would be especially nice if your hospital was similar in size to ours and/or has the challenge of being greater than 60 miles from your blood supplier. 

Thanks in advance!

Five Platelets sounds way high.  We are similar in size and we ARE a Trauma center and we only stock 3 on weekdays and 2 on weekends.  We are 1.5 hours away from our blood supplier.  They rotate our platelets 6 days a week so we are always getting fresh platelets to help reduce waste.  Of course this is contingent upon their supply, so if they don't get fresh ones in, then they have us keep the ones we have.  Our newest neurosurgeon is very annoyed if he gets in a patient and we have given our platelets to other patients, even though that is a rarity, but he doesn't get a say in our stock levels.

Our hospital is the same size and is not yet designated as a Trauma Center.  We try to have 3-4 platelets in-house at all times for all patients, sometimes we go lower though esp on weekends.  Keeping 5 on hand at all times JUST for brain bleeds is a little much.  It's not like platelet transfusions save every bleed; we started stocking KCentra in the Pharmacy for the bleeds due to Coumadin overdoses.  Our indications for platelets are <100K for brain bleeds, or if there is platelet dysfunction (usually due to Plavix).

Cryo can help platelets work better according to a speaker we had who recommended using it for JW's who would accept cryo but not platelets. Cryo is much more shelf-stable and pretty quick to prepare if pre-pooled.  Maybe you could research that and offer that as a backup for the extreme cases he is planning for.  Is it proven that Plavix patients with brain bleeds given many doses of platelets actually have better outcomes?  My sense is that the platelets don't do too much except help the providers feel better--at least not quickly enough to change outcomes--but I haven't read any research on it in recent years.  Maybe ask him to provide the research that he feels justifies the request for your medical director or transfusion committee to review?

This may be a silly question...but are you sure he understands the difference between pheresis and random donor?  The vast majority of our physicians still order 5-6 packs of platelets even though we have only carried pheresis for 10+ years.

That's a great question, but yes, I am sure the neurosurgeon understands the difference between a pheresis unit and a 6-pack.

As a follow-up, I enlisted the help of 2 other physicians on the transfusion committee and hopefully, we will be setting up a meeting soon, to discuss parameters of needs and what we can reasonably provide. 

Thanks All, for the input.

I still see the same thing as Sko681, occasionally.

We're about the same size as your institution kirkaw but ~10 miles from our blood supplier. We keep one pheresis platelet on hand at all times.

we are level 1 trauma center with 400 bed. we keep only two pheresis on hand and our supplier is 1.5 hrs away.