Platelet transfusions

Platelets are usually administered in 10 ml/kg aliquots over 1 hour. Infants receive type specific or group O platelets in plasma compatible with the patient. All platelets given in the NICU are leukofiltered and irradiated. (Leukofiltration diminishes the risk of CMV transmission and obviates the need for CMV-seronegative products.)

Platelets should be filtered and administered through peripheral venous access.

Thresholds for platelet transfusions

1. An otherwise stable, healthy term infant (with for ex. alloimmune thrombocytopenia) may be allowed a platelet count as low as 20,000-30,000.
2. All unstable term infants and all preterm infants should receive prophylactic platelet transfusions to keep their platelet count >50,000.
3. Patients receiving indomethacin or thrombolytics/anticoagulants should have platelet counts > 75,000.
4. A patient on ECMO is transfused for platelets 80,000-100,000.
5. A neonatal patient with diffuse microvascular bleeding should be transfused to achieve a platelet count > 100,000.

These guidelines are also available in the 2001 NICU Manual pg. 8-6 and the NICU Nursing Guidelines 40:08.30.

References:

Christensen RD, ed. "Consistent approaches to procedures and practices in neonatal hematology." Clin Perinatol 2000; 27 (3): 733-754.