chapter 49. quiz 4 Platelet Concentrates Overview

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Questions and Answers

What is the storage duration of platelets if they are kept at room temperature?

5 days

10 days

7 days (correct)

14 days

What is the main cause of transfusion-related deaths related to platelet concentrates?

Viral contamination

Bacterial contamination (correct)

Incompatibility reactions

Platelet count mismatch

What storage duration for multidonor platelet products results in a higher incidence of sepsis?

2 days

4 days

5 days (correct)

1 day

What is the approximate rate of bacterial contamination in actively surveyed transfused platelets?

1 per 2500 units Signup and view all the answers

What is the percentage of patients exposed to contaminated platelet products that developed a septic transfusion reaction?

25% Signup and view all the answers

What is the storage condition for platelet concentrates?

Stored at room temperature Signup and view all the answers

When should sepsis from platelets be considered in a patient?

If they develop a fever within 6 hours after receiving platelets Signup and view all the answers

According to the ASA Task Force guidelines, when might platelet transfusion be indicated despite an adequate platelet count?

If there is known or suspected platelet dysfunction Signup and view all the answers

In which range is prophylactic platelet transfusion rarely indicated in surgical or obstetric patients according to the guidelines?

>100 × 10^9/L Signup and view all the answers

What type of patients may require therapy with intermediate platelet counts (50-100 × 10^9/L) based on the guidelines?

Patients with a high risk of bleeding Signup and view all the answers

Platelet concentrates are obtained as

4 to 6 whole-blood donations Signup and view all the answers

What is the minimum platelet count threshold that may be required in patients receiving chemotherapy for prophylaxis?

10 × 10^9/L Signup and view all the answers

For patients undergoing neurosurgery, what platelet count may be targeted according to the text?

100 × 10^9/L Signup and view all the answers

What is the recommended platelet count range for patients undergoing bone marrow biopsy or lumbar puncture?

20-30 × 10^9/L Signup and view all the answers

which of the following Patients usually require platelet transfusion?

thrombocytopenia (<20 × 10/L) and clinical signs of bleeding Signup and view all the answers

in which patients platelet transfusions increased the risk of death

patients with antiplatelet therapy and intracerebral hemorrhage Signup and view all the answers

Why is aggregation not used for matching platelets?

Platelets cause clumping Signup and view all the answers

What makes detection of recipient antibodies on platelets difficult?

Presence of immunoglobulins on the platelet membrane Signup and view all the answers

Why are ABO-incompatible platelets often chosen for transfusions despite certain challenges?

They still provide very adequate hemostasis Signup and view all the answers

What is the usual increase in platelet count seen 1 hour after transfusing one platelet concentrate in a 70-kg adult?

$7$ to $10$ x $10^9/L$ Signup and view all the answers

What factor may lead to decreased survival and recovery of transfused platelets?

Previous sensitization to platelets Signup and view all the answers

Which type of platelet concentrates has been proposed as an alternative according to the text?

Leukocyte-depleted platelets Signup and view all the answers

What was the outcome when severe trauma patients received 4 units of thawed plasma after already receiving 1 unit of RBCs?

Reduction in 30-day mortality Signup and view all the answers

Why do some trauma centers keep thawed plasma readily available?

To expedite the availability of plasma for critical care patients Signup and view all the answers

What is the main difference between Fresh Frozen Plasma (FFP) and plasma frozen within 24 hours (PF24)?

PF24 contains less factor V and approximately 25% decrease factor VIII than FFP Signup and view all the answers

What are some of the risks associated with Fresh Frozen Plasma (FFP) administration?

TRALI, TACO, allergic or anaphylactic reactions Signup and view all the answers

What is the recommended storage duration for thawed plasma?

Up to 5 days at 1 °C to 6 °C Signup and view all the answers

When should coagulation studies be obtained prior to the administration of Fresh Frozen Plasma (FFP)?

When INR is greater than 2, in the absence of heparin Signup and view all the answers

Which of the following is NOT mentioned as a guideline for administering Fresh Frozen Plasma (FFP) according to the ASA Task Force in 2015?

Using FFP for intravascular volume replacement without any restrictions Signup and view all the answers

which plasma proteins particularly found in FFP?

factors V and VIII Signup and view all the answers

what happens to the coagulation factors found in FFP with the time?

gradually decline during the storage of blood. Signup and view all the answers

What is the primary function of fibronectin in cryoprecipitate?

Clearing foreign particles and bacteria from blood Signup and view all the answers

Why should cryoprecipitate be administered through a filter?

To remove RBC fragments Signup and view all the answers

What is the recommended rate of administration for cryoprecipitate?

200 mL/h Signup and view all the answers

When is transfusion of cryoprecipitate rarely indicated according to the 2015 ASA Task Force on Perioperative Blood Management?

When fibrinogen levels are greater than 150 mg/dL Signup and view all the answers

Why is ABO compatibility not considered crucial for cryoprecipitate administration?

Low concentration of antibodies in cryoprecipitate Signup and view all the answers

In which situation would the administration of cryoprecipitate be indicated based on the guidelines?

When fibrinogen concentrations less than 80-100 mg/dL Signup and view all the answers

which coagulation factors found in CRYOPRECIPITATE ?

factor VIII , factor XIII, fibrinogen Signup and view all the answers

which of The following is indications for the administration of cryoprecipitate:

<ol start="7"> <li>In bleeding patients with von Willebrand disease and concentrates are not available</li> </ol> Signup and view all the answers

the transition from whole blood to PRBCs lead to ?

incidence of coagulopathies increased Signup and view all the answers

What was the concept that evolved when transitioning from whole blood to PRBCs?

Development of ratios of FFP and/or platelet concentrates with PRBCs Signup and view all the answers

What does a 1:1:1 transfusion ratio represent in terms of blood components?

1 unit of plasma, 1/6 unit of platelets, 1 unit of RBCs Signup and view all the answers

Why is one-sixth unit of platelets commonly used in transfusion ratios?

Because it aligns with donor allocation practices Signup and view all the answers

What did Holcomb and associates find regarding platelet ratios and survival after massive blood transfusions?

Increased platelet ratios were tied to improved survival outcomes Signup and view all the answers

What conclusion did Holcomb and colleagues reach regarding the administration of plasma, platelets, and red blood cells?

No differences in mortality at 24 hours or at 30 days between ratios Signup and view all the answers

According to the PROMMTT study, what was associated with decreased mortality in patients receiving transfusions of at least 3 units of blood products within the first 24 hours after admission?

Higher plasma and platelet ratios Signup and view all the answers

What was a finding from the laboratory clotting profile study by Kornblith and associates regarding a 1:1:1 plasma/platelets/RBC ratio?

more hemostatic properties compared to a 1:1:2 ratio Signup and view all the answers

What risk was associated with aggressive plasma administration to transfused patients as mentioned in the text?

Higher incidence of ARDS and organ dysfunction Signup and view all the answers

Study Notes

Platelet Storage and Transfusion

Platelets kept at room temperature have a storage duration of 5-7 days.
The main cause of transfusion-related deaths related to platelet concentrates is bacterial contamination.
Storage duration of more than 5 days for multidonor platelet products results in a higher incidence of sepsis.
The approximate rate of bacterial contamination in actively surveyed transfused platelets is 1 in 2,000 to 1 in 3,000.
About 25-30% of patients exposed to contaminated platelet products develop a septic transfusion reaction.
Platelet concentrates are stored at room temperature.
Sepsis from platelets should be considered in a patient with fever, tachycardia, and tachypnea within 4-6 hours of transfusion.

Platelet Transfusion Indications

Platelet transfusion may be indicated despite an adequate platelet count if there is evidence of bleeding or a high risk of bleeding.
Prophylactic platelet transfusion is rarely indicated in surgical or obstetric patients with a platelet count above 50,000/μL.
Patients with platelet counts between 50,000/μL and 100,000/μL may require therapy, such as those with platelet dysfunction or bleeding.
The minimum platelet count threshold that may be required in patients receiving chemotherapy for prophylaxis is 10,000/μL.
For patients undergoing neurosurgery, a platelet count of 100,000/μL may be targeted.
The recommended platelet count range for patients undergoing bone marrow biopsy or lumbar puncture is 20,000/μL to 50,000/μL.
Patients with platelet counts below 50,000/μL usually require platelet transfusion.
Platelet transfusions increased the risk of death in patients with acute myeloid leukemia.

Platelet Matching and Aggregation

Aggregation is not used for matching platelets because it requires platelet activation, which can lead to loss of function.
Detection of recipient antibodies on platelets is difficult due to the large number of antibodies that may be present.
ABO-incompatible platelets are often chosen for transfusions despite certain challenges because of the limited availability of ABO-compatible platelets.

Platelet Transfusion Outcomes

The usual increase in platelet count seen 1 hour after transfusing one platelet concentrate in a 70-kg adult is 30,000-60,000/μL.
Factors that may lead to decreased survival and recovery of transfused platelets include ABO incompatibility, prior sensitization, and medication.
Single-donor apheresis platelets have been proposed as an alternative to multidonor platelet concentrates.

Plasma and Cryoprecipitate

Fresh Frozen Plasma (FFP) and plasma frozen within 24 hours (PF24) differ in their storage duration and availability of labile coagulation factors.
The risks associated with FFP administration include transfusion-related acute lung injury (TRALI), allergic reactions, and volume overload.
The recommended storage duration for thawed plasma is 5 days.
Coagulation studies should be obtained prior to the administration of FFP if the patient is bleeding or has a coagulopathy.
The administration of FFP is rarely indicated for correction of mild coagulopathy or for laboratory values without clinical bleeding.

Cryoprecipitate

The primary function of fibronectin in cryoprecipitate is to promote platelet aggregation and adhesion.
Cryoprecipitate should be administered through a filter to prevent clots and microaggregates.
The recommended rate of administration for cryoprecipitate is slowly, over 1-5 minutes.
Transfusion of cryoprecipitate is rarely indicated for minor bleeding or oozing.
ABO compatibility is not considered crucial for cryoprecipitate administration because it is a low-volume component.

Blood Component Ratios

The transition from whole blood to PRBCs led to a shift in blood component ratios, with a concept of component therapy evolving.
A 1:1:1 transfusion ratio represents equal units of plasma, platelets, and red blood cells (RBCs).
One-sixth unit of platelets is commonly used in transfusion ratios because it represents the platelet content of a single unit of whole blood.
Holcomb and associates found that a higher plasma-to-RBC ratio was associated with improved survival after massive blood transfusions.
The administration of plasma, platelets, and RBCs in a 1:1:1 ratio may reduce mortality in patients receiving massive blood transfusions.

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Description

This quiz covers the basics of platelet concentrates, including the two main types obtained and their storage conditions. It also includes information on bacterial contamination risks and transfusion-related deaths.