Principle: | Clinical Significance: | Specimen: | Materials: | Reagents: | Standardization: N.A. | Procedure: | Limitations: N.A. | Results Derivation: | Expected Result(s) | Quality Control: | References:
The treatment of the bleeding thrombocytopenic patient is the prime clinical use of platelet concentrate. Platelets promote hemostasis in three ways:
1. The platelets are incorporated into the endothelial walls to strengthen them.
2. The platelets form platelet thrombi in the presence of collagen and thrombin.
3. The release of platelet factor 3, a lipoprotein aids in the formation of a fibrin clot.
II. Clinical Significance: N.A.
A. Rh(D) negative females less than 45 years of age must receive Rh(D) negative platelets.
B. Infants less than 4 months of age must be given ABO compatible platelets.
2. Historical type is acceptable or refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.
Refer to Materials section within the “General Processes, Blood Bank” protocol.
1. Hand sealer
2. Hand sealer clips
3. Platelet rotator or rocker
4. Rubber bands
If an ABO or Rh is required, refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.
VI. Standardization: N.A.
Type specific platelets must be given to Rh(D) negative women of childbearing age.
Infants must be given ABO compatible platelets. Historical type is acceptable or refer to the “ABO Group and Rh Type, Patient; MTS Monoclonal Grouping Cards” procedure.
1. There are two types of platelet products:
A. Pheresis or single donor platelets: The only platelet product accepted by hospitals under the direction of Pathology Associates (PA).
Pheresis or single donor platelets are collected from one donor using cytopheresis technology. The product contains a concentration of platelets equivalent to up to 8 random donor platelets and is pre-storage leukocyte reduced. The supplier monitors each bag for the presence of bacterial contamination.
B. Random donor platelets: Product not accepted by hospitals under the direction of PA.
Random donor platelets are a suspension of platelets in plasma prepared by centrifugation of whole blood. A quantity of 6 or more random platelets constitutes a dose. The product is not pre-storage leukocyte reduced. In addition, the product is not currently monitored for bacterial growth by the supplier, therefore it is required that a gram stain be performed on each bag prior to issuing for transfusion.
Warning: Never order random donor platelets. Never accept random donor platelets as a substitute for single donor platelets (pheresis).
A. Routine orders:
Both Dubuque Hospital transfusion services store pheresis platelets at all times. Transfer of these products between UCL sites is acceptable. Refer to the “Inventory Management, Blood and Blood Components” protocol.
B. Irradiated pheresis platelets:
Both Dubuque hospitals store one irradiated platelet pheresis. Call the supplier and request additional stock as needed. MMC-Dyersville can obtain irradiated platelets from either Dubuque hospital or the blood supplier.
C. HLA typed/matched:
Orders for HLA matched platelets should be referred to a pathologist for approval prior to ordering from the blood supplier. Availability of this product depends on the accessibility of matching donors. Forms for HLA typing and product orders can be found on the Mississippi Valley Regional Blood Center (MVRBC) Online Ordering website via the “Forms” button.
a. “Histocompatibility/Test Req” form is needed for HLA typing only.
b. “Request Form and Patient Information for HLA Matched Platelet Pheresis” and “Special Product Request Form – HLA Platelets” forms are needed when ordering products.
A. Place the platelet bag(s) on a platelet rotator or rocker. Both Dubuque hospitals have a continuous monitored platelet incubator.
B. If platelets are stored in an open area, check the temperature of the storage area. It must be maintained between 20 - 24°C. There is a continuous chart recorder for the recording of the temperature in the platelet storage area.
C. Record the temperature on the appropriate log or chart. If platelets are being stored and the recorded temperature is outside the posted limits, the platelets must be moved to another area of the lab in which the temperature is within range or they can be left in the transport box until they are transfused. An entry must be made in the appropriate incidence log.
A. No preparation is required for single bag pheresis.
B. Some pheresis platelets come separated into two bags. These will need to be combined into one bag just prior to transfusion.
a. Open the clamp between the 2 units.
b. Hold the bag with no product information above the bag with the complete product information and allow the platelets to pool into the bag with the complete product information.
c. Close the clamp, crimp the tubing in 2 places, using the hand sealer and hand sealer clips, and cut the tubing between the two clips.
d. Discard the empty bag.
e. Wipe the end of the tubing with gauze or paper toweling to ensure that it is dry before releasing the product to the nursing station.
f. Change the expiration date to 4 hours from the time of pooling on both the product and in SafeTrace (see the Product Selection; Double-Bag Pheresis section within the “FFP, PLT, Cryo Product Selection” procedure) unless the actual expiration date of the product is sooner.
The current blood supplier, Mississippi Valley Regional Blood Center has incorporated the BacTAlert System to detect bacterial contamination of the pheresis platelet product. The product may be stored at a hospital site at the time that a positive culture is detected. If a positive result is identified on a product in storage, the blood center will notify the appropriate facility.
A. If the product is still in storage, it is to be moved to the lower shelf, which is identified with red tape as the “Quarantine Shelf”. Attach a yellow quarantine tag to the product. Place the product at Quarantine status in the SafeTrace System. (Refer to the “Quarantine; SafeTrace” protocol.)
B. If the product has been transfused, refer to the “Blood Products Lookback and Response” protocol.
Platelets are transfused as fast as can be tolerated by the patient. The longer the transfusion takes, chances of receiving viable platelets decreases. Platelets settle out of suspension quickly and being very adhesive, have a tendency to stick to the sides of the pack.
VIII. Limitations: N.A.
IX. Results Derivation: N.A.
X. Expected Result(s) and/or Critical Values: N.A.
XI. Quality Control: N.A.
1. Committee on Standards,"AABB Standards for Transfusion Services", American Association of Blood Banks, current edition.
2. American Red Cross, American Association of Blood Banks, "Circular of Information for the use of Human Blood and Blood Components", current edition.
2. Committee on Technical Manual,"AABB Technical Manual", American Association of Blood Banks, current edition.
i. 8-1-83 M. English
ii. 6-5-91 J. Schultz
iii. 2-23-94 M. English/M. Burger (Revised: VII.3.G. & 4.A -E)
iv. February 98 B. Lucas (Revised: VII.F.)
v. January 2001 M. Burger/S. Hosch (Revised: III., VII.1-2., XI.)
vi. October 2003 M. Burger (Revised: IV., VII.1, 3.; XII.; format)
vii. February 2004 M. Burger (Revised: IV., VII.1.,3.,4.)
viii. July 2006 M. Burger, S. Hosch, S. Rodriguez (Revised: III.1.A-B.)
ix. August 2007 M. Burger, S. Hosch, S. Rodriguez (Revised: VII.2.C.)
September 2009 S. Hosch (no changes)
October 2011 K. Moore (Revised: III.1.B.age)