Platelet Transfusion

Excerpt

Since the first attempted blood transfusion in the 17th century, blood transfusion has evolved from transfusing whole blood to utilizing only its components for select indications such as packed red blood cells (RBC), platelets, rarely white blood cells (WBC), frozen plasma, and plasma-derived products. Platelets play an integral role in hemostasis through their response to vascular injury. The relevance of platelet component therapy was better understood in the 1950s and 1960s when severe and fatal hemorrhagic complications of chemotherapy in leukemia were studied.

In the middle of the last century, blood was collected in glass bottles, which depleted platelets in storage. Around the same time, the introduction of plastic bags revolutionized blood storage. It was also found to be gas permeable, which is essential for storing functional platelet. Over time, with the development of efficient separation techniques, platelet component with high platelet yield has been achieved with apheresis, and changes in safety protocol reduced adverse outcomes of transfusions. A great deal has been done to minimize adverse outcomes, and further safety protocols are being explored.

Platelet concentrates (PC) are widely used to support patients with severe thrombocytopenia. These could be patients with hematologic malignancy, bone marrow failure, or other immune and non-immune causes of platelet destruction, though rare cases could warrant transfusion with normal platelet counts. Platelet is a scarce resource, partly because of their short shelf life of 5 days; it is classified in the World Health Organization’s (WHO) list of “Essential Medicine.”