Chapter 43 ■ Transfusion of Blood and Blood Products 309

D. Equipment and Technique

1. Platelets

a. Random donor platelet concentrate (5.5 × 1010

platelets in 40 to 70 mL of plasma)

(1) Separated from WB by centrifugation within 8

hours of blood draw and resuspended in plasma

(2) Shelf life of 5 days

b. Volume-reduced platelets

(1) Standard platelet concentrate further concentrated to a volume of 15 to 20 mL by centrifugation

(2) Associated with loss of platelets and possible

decrease in platelet function

(3) Shelf life reduced to 4 hours

(4) Use only if infant has oliguria, severe volume

load sensitivity

c. Apheresis platelets (3 × 1011 platelets in volume of

250 mL plasma)

(1) Removes only platelets, returns RBCs and

plasma to donor

(2) Usually LD before storage

(3) Permits repeated donations from same donor

every 48 hours under select circumstances

(4) High yield of platelets

(5) More expensive product

(6) Useful when multiple platelet transfusions of a

particular antigen specificity are required, as in

neonatal alloimmune thrombocytopenia (NAIT)

or for infants on extracorporeal membrane oxygenation needing multiple platelet transfusions.

(7) May be HLA-typed or typed for HPA-1 or other

specific platelet antigen in case of NAIT.

(8) Maternal plateletpheresis product is preferred

for NAIT. Use maternal antigen-negative platelets, washed, irradiated, and resuspended in

ABO group-compatible plasma or saline.

2. Calculate volume of platelets to transfuse based on type

of product.

a. 10 to 15 mL/kg of random platelet provides 10 × 109

platelets/kg and should increase platelet count by

approximately 50 × 109

/L in the absence of ongoing

consumption. Can use same calculations for apheresis platelets, but studies do not confirm posttransfusion increments.

b. Advise use of equivalent unit (EU) calculations and

not mL/kg for dosing apheresis platelets.

c. 1 EU is the volume of a platelet aliquot that has a

minimum platelet content of 5.5 × 1010 platelets

(approximately 1 random donor platelet concentrate).

d. The standard dose based on this method is 1 EU/5

to 10 kg, with a minimum dose of 1 EU. Volume

reduction may be necessary for some extremely lowbirthweight infants.

e. Other products (HLA-matched, cross-matched

platelets) used for platelet refractoriness; washed

platelets if using HPA-matched maternal apheresis

platelets.

3. Blood administration set with 120- to 170-mm inline filter, unless platelets have been prefiltered while drawing

into a syringe. Specific sets designed for plasma/platelets have inline filters with reduced surface area to

increase platelet transfusion efficacy.

4. Sterile syringe for automated pump infusion. Use of

syringe technique will increase damage to platelets.

Administer by drip if clinically feasible.

5. Automated syringe pump

6. Connecting IV tubing

7. IV access, preferably through 23-gauge or larger needle

or through umbilical venous catheter

8. Normal saline flush solution

E. Technique for Platelet Administration by

Automated Syringe

1. Estimate by weight the volume of platelets in a single

bag to determine fluid load to infant.

2. Confirm correct platelet product.

a. Infant and unit identification

b. Infant and donor blood group, and Rh type

c. Check other restrictions: CMV negative, irradiated,

etc.