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Blood products - platelets (Newborn Services)

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Blood components available for platelet transfusion of neonates

New Zealand Blood Service provides a dedicated platelet concentrate for neonatal use. This is derived from an apheresis donation which has been split into 4 components using sterile systems.

All blood components provided by NZBS are leucodepleted at source and CMV negative (see special considerations below). Statistical process control is used to ensure that greater than 99% of components will have a level of <5 x 106 WBC per unit (95% confidence). A detailed datasheet on this component can be accessed on the New Zealand Blood Service website (www.nzblood.co.nz).

Indications

Vary for individuals but below are guidelines:

  • Thrombocytopenia (platelets reduced)
  • Thrombasthaenia (platelets not functioning)

Table 1. Platelet count and indications for transfusion

Platelet Count (x109) Indications for transfusion
 <20  - All neonates (except in maternal ITP unless there is active bleeding)
 <30  - Neonates <1000g and <7 days 
 - Clinically unstable (e.g. fluctuating BP) 
 - Previous major bleeding (e.g. Grade 3-4 IVH, pulmonary haemorrhage) 
 - Current minor bleeding 
 - Concurrent coagulopathy 
 - Requiring surgery or exchange transfusion 
 - Neonatal Alloimmune Thrombocytopenia (NAIT)
 <50   - Major haemorrhage
May be given as part of the Massive Transfusion Protocol

Special considerations when transfusing neonates

Cytomegalovirus (CMV) infection

Infants weighing less than 1.5kg, those with immunodeficiency and stem cell transplant recipients are at greatest risk of transfusion transmitted CMV disease. These infants should receive CMV antibody negative blood components.

Blood components produced for neonatal use by NZBS are normally CMV antibody negative. In certain specific settings this may not however be possible. When CMV antibody negative components are not available then the transfusion of leucodepleted components is an acceptable alternative

Irradiation of blood components

Detailed Guidelines on irradiation of blood components produced by the Australian and New Zealand Society for Blood transfusion (ANZSBT) can be obtained on the NZBS website (www.nzblood.co.nz)

Irradiation is used to reduce the risk of Transfusion associated Graft versus Host disease (TA-GvHD).

Irradiated components are required for:

  • Infants with known or suspected immunodeficiency disorders
  • Infants who have received intrauterine transfusions
  • Infants transfused with directed donations (from family relatives)
  • Exchange transfusion where irradiation will not unduly delay transfusion

Routine irradiation of cellular blood components outside of the above is not required by current international guidelines.

Volume restriction

Infants who require transfusion but who may be unable to tolerate the volume required for standard neonatal products may benefit from reduced volume platelet concentrates. These are manufactured on demand and require approval from an NZBS Transfusion Medicine Specialist. During Monday to Friday platelet concentration can be reduced to 20ml if the Blood Bank is notified by early afternoon.

Neonatal Alloimmune Thrombocytopenia (NAIT)

When NAIT is suspected advice on diagnosis and management should be sought from an NZBS Transfusion Medicine Specialist. Where feasible, platelet support will be provided from Human Platelet Antigens (HPA) compatible donors (platelets negative for both HPA-1a and HPA-5b). When this is not possible then washed maternal platelets may be required. Additional treatment with intravenous immunoglobulin could be considered in some cases.

Prescribing of Platelets

Prescribed on the blood transfusion/IV fluid chart (CR5541).

Volume to Transfuse:
Platelet concentrate contains 55 x 109 platelets in 50ml.
Normally give 10ml (11 x 109) per kg, which is expected to raise count by approximately 110 x 109/L.

Ordering

One unit of platelet concentrate can be ordered over 24 hours for one baby without contacting the NZBS Medical Officer. However, for more, or daily concentrates, please discuss with the NZBS Medical Officer.

Remember that every effort must be made to reduce exposure of neonatal patients to blood products and separate blood donations. The infant should receive ABO and Rh(D) matched platelets to reduce the risk of transfer of anti-A or anti-B in the plasma of type O platelets.

Ring ARBC during office hours or Auckland BB after hours to speak to duty medical specialist. They may ask you for the following details:

  • Patient name
  • NHI
  • Blood group
  • Red cell antibodies (if there are any)
  • Ward number
  • Baby's weight
  • Current platelet count
  • Clinical indications for platelet transfusion
  • Whether there are any restrictions on volume that can be infused and also whether there are coagulation factor deficiencies (only platelets made the same day will  have plasma rich in clotting factors)

Fill in the NZ Blood Request for Blood Bank Tests and Blood Components or Products form. You will also need to complete a Blood Bank Issue Sheet form CC7029.

Administration

  1. Obtain informed consent - parent signs on Agreement to Treatment form CR0111.
  2. Use platelets as soon as they arrive on the ward. They must be kept at room temperature and NOT refrigerated
  3. Mix well before use
  4. The appropriate volume of platelet concentrate should be drawn into a new plastic syringe using a 170 micron blood filter.
  5. Volume to transfuse:
    Platelet concentrate contains 55 x 109 platelets in 50ml.
    - Normally give 10ml (11 x 109) per kg, which is expected to raise count by approximately 110 x 109/L
  6. Infuse over 30 - 60 minutes, mixing syringe from time to time to avoid platelets settling out. Transfusion should be complete within 1 hour of issue from blood bank.
  7. Check post-transfusion platelet count

Complications

Platelets contain a few red cells. Therefore an Rh negative baby receiving platelets from an Rh positive donor will need Anti-D 0.5ml (about 62ug) subcutaneously within 72 hours (usually straight away) after the platelets to prevent baby producing own Anti-D. Subsequent infusions of platelets - if Anti-D is detectable in baby's blood there is no need to give more Anti-D subcutaneously. One injection per week is generally sufficient. If in doubt check baby's serum for presence of Anti-D.

The usual infections risk of blood transfusion apply also to platelets, e.g. HIV, HBV, HCV and NANB hepatitis, CMV, Syphilis, Malaria, etc or bacterial contamination of the products.

For information on checking, administration, monitoring, documentation and transfusion reactions, see   Blood products - red cell transfusion

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Document Control

  • Date last published: 01 August 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years