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Higher platelet transfusion thresholds have been used in premature neonates, but this has been based on limited evidence. [19] There is now evidence that using a high platelet count threshold (50 x 10 9 /L) increases the risk of death or bleeding compared to a lower platelet count threshold (25 x 10 9 /L) in premature neonates. [20]
In a typical set of rules, a platelet donor must weigh at least 50 kg (110 lb) and have a platelet count of at least 150 x 10 9 /L (150,000 platelets per mm³). [2] One unit has greater than 3×10 11 platelets. Therefore, it takes 2 liters of blood having a platelet count of 150,000/mm³ to produce one unit of platelets.
A normal platelet count ranges from 150 to 400 x10 9 /L, but these patients can have platelet counts well below 50 x 10 9 /L. These low platelet counts are associated with an increased bleeding risk. Generally, platelet transfusions are given at a threshold of 10 x10 9 /L in order to increase the number of circulating platelets.
One common definition of thrombocytopenia requiring emergency treatment is a platelet count below 50,000/μL. [5] Thrombocytopenia can be contrasted with the conditions associated with an abnormally high level of platelets in the blood – thrombocythemia (when the cause is unknown), and thrombocytosis (when the cause is known). [6] [7]
The single unit policy is helpful in platelet transfusion as there this blood component has a short shelf-life than other components. Assessment after one bag can include assessing clinical bleeding, platelet count looking at the post transfusion increment and/or functional platelet assessments.
If antigen negative platelets are unavailable, then standard neonatal platelet transfusions should be given until antigen negative platelets become available. [20] [19] If a platelet transfusion is not available immediately then the infant can be given IVIG (1g/kg) however, this will have no effect on the platelet count before 24 to 72 hours. [19]
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