Platelet Transfusions in Children
Clinical Overview
Transfusion Specifications: Standard dose 10-15 mL/kg, aiming for post-transfusion increment of 50,000-100,000/µL. Critical platelet parameters: ABO compatibility preferred, temperature-controlled (20-24°C), agitation required, 4-hour infusion window post-release.
Protocol Requirements:
- Baseline coagulation profile: PT, aPTT, fibrinogen
- Documentation: pre/post platelet counts, transfusion reactions
- Volume calculation: [(desired - current platelet count) × weight × 0.07]
- Product validation: unit number, expiration, crossmatch verification
Clinical Thresholds
Prophylactic Thresholds: <10,000/µL stable patients; <20,000/µL with risk factors; <50,000/µL for surgery/invasive procedures; <100,000/µL for CNS procedures or major hemorrhage.
Critical Indications:
- Acute hemorrhage with thrombocytopenia or platelet dysfunction
- DIC with active bleeding: maintain >50,000/µL
- ECMO/cardiac bypass: target 80,000-100,000/µL
- Chemotherapy-induced thrombocytopenia with bleeding
Administration Protocol
Infusion Parameters: Initial rate 1-2 mL/kg/hr for first 15 minutes; increase to 2-4 mL/kg/hr if tolerated. Maximum infusion time 4 hours. Direct venous access required, minimum 22G catheter.
Critical Steps:
- Pre-transfusion: vital signs, patient identification, consent
- Inline filter (170-200 micron) mandatory
- No concurrent medications through transfusion line
- Vital sign monitoring: baseline, 15 min, completion
Product Specifications
Component Requirements: Unit volume 50-70 mL, containing ≥3.0×10¹¹ platelets/unit. Storage conditions: continuous gentle agitation, 20-24°C, 5-7 day shelf life depending on collection method.
Product Selection Criteria:
- Single-donor apheresis preferred for alloimmunized patients
- HLA-matched products for refractory cases
- CMV-seronegative for at-risk populations
- Irradiation required: oncology, HSCT, congenital immunodeficiency
Clinical Monitoring
Assessment Parameters: CCI at 1-hour and 24-hours post-transfusion. Poor increment defined as 1-hour CCI <7,500 or 24-hour CCI <4,500. Refractoriness evaluation after two consecutive suboptimal responses.
Monitoring Protocol:
- Vital signs: q15min first hour, then hourly
- Bleeding assessment using WHO bleeding scale
- Post-transfusion platelet count within 1 hour
- Documentation of transfusion efficacy
Adverse Events Management
Primary Complications: FNHTR (0.5-3%), allergic reactions (0.5-3%), TRALI (<0.1%), bacterial contamination (1:2,000-1:3,000 units), anaphylaxis (rare). Management protocols specific to each reaction type required.
Immediate Interventions:
- FNHTR: antipyretics, temporary rate reduction
- Allergic: antihistamines, consider corticosteroids
- TRALI: respiratory support, hemodynamic monitoring
- Bacterial contamination: broad-spectrum antibiotics, cultures
Special Populations Management
Population-Specific Protocols: Neonates require volume-reduced products (10-15 mL/kg). Oncology patients require irradiated products within 14 days of collection. NAIT cases require antigen-negative platelets.
Critical Considerations:
- Neonatal alloimmune thrombocytopenia: HPA-1a/5b negative
- Oncology: CMV-negative, irradiated products
- ITP: IVIG consideration before transfusion
- Apheresis products for HLA-alloimmunized patients
Quality Standards
Regulatory Requirements: AABB standards compliance mandatory. Quality indicators include: pH >6.2, sterility maintenance, adequate platelet count per unit, proper temperature monitoring.
Quality Assurance Measures:
- Product validation: swirling, pH, sterility testing
- Storage compliance: continuous temperature monitoring
- Documentation: product processing, modification records
- Staff competency: annual assessment, procedure validation
Platelet Transfusions in Children
- What is the primary indication for platelet transfusion in children?
Answer: Prevention or treatment of bleeding due to thrombocytopenia or platelet dysfunction - What is the typical threshold for prophylactic platelet transfusion in stable patients?
Answer: 10,000/µL (10 x 10^9/L) - How many units are in a standard adult dose of platelets?
Answer: 4-6 units (one apheresis unit) - What is the recommended dose of platelets for children?
Answer: 10-15 mL/kg or 1 unit per 10 kg body weight - Which of the following is not a common cause of thrombocytopenia in children?
Answer: Polycythemia vera - What is the expected increment in platelet count after a standard dose transfusion?
Answer: 30,000-50,000/µL - How long do transfused platelets typically survive in circulation?
Answer: 3-5 days - What is the maximum storage time for platelets at room temperature?
Answer: 5-7 days - Which of the following is a sign of platelet refractoriness?
Answer: Failure to achieve expected increment after two consecutive transfusions - What is the most common cause of immune-mediated platelet refractoriness?
Answer: HLA alloimmunization - Which blood group antigen is expressed on platelets?
Answer: ABO antigens - What is the recommended platelet count threshold for major surgery or invasive procedures?
Answer: 50,000/µL - Which of the following conditions typically requires a higher platelet transfusion threshold?
Answer: Intracranial hemorrhage - What is the primary difference between random donor platelets and apheresis platelets?
Answer: Apheresis platelets are collected from a single donor, while random donor platelets are pooled from multiple donors - Which of the following is not a typical indication for platelet transfusion?
Answer: Immune thrombocytopenia (ITP) without active bleeding - What is the recommended method for ABO compatibility in platelet transfusions?
Answer: ABO-identical or ABO-compatible - Which of the following is a potential complication specific to platelet transfusions?
Answer: Bacterial contamination - What is the recommended storage temperature for platelets?
Answer: 20-24°C with continuous gentle agitation - Which test is commonly used to assess the effectiveness of platelet transfusions?
Answer: Corrected count increment (CCI) - What is the typical volume of an apheresis platelet unit?
Answer: 200-300 mL - Which of the following is not a typical cause of non-immune platelet refractoriness?
Answer: ABO incompatibility - What is the recommended platelet count threshold for lumbar puncture in children?
Answer: 50,000/µL - Which of the following medications can affect platelet function and should be considered before transfusion?
Answer: Aspirin - What is the primary advantage of using platelet additive solutions?
Answer: Reduced plasma volume and decreased risk of allergic reactions - Which of the following is not a typical sign of a successful platelet transfusion?
Answer: Immediate cessation of all bleeding - What is the recommended maximum time for administering a unit of platelets?
Answer: 4 hours - Which of the following conditions may require HLA-matched platelet transfusions?
Answer: Platelet refractoriness due to HLA alloimmunization - What is the primary reason for using leukoreduced platelet products?
Answer: To reduce the risk of febrile non-hemolytic transfusion reactions and HLA alloimmunization - Which of the following is not a typical indication for therapeutic platelet transfusion?
Answer: Stable patient with platelet count of 15,000/µL - What is the recommended approach for platelet transfusion in neonates with alloimmune thrombocytopenia?
Answer: Use of antigen-negative or washed maternal platelets
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The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
