Are there any side effects to platelet transfusion

For some people who are prone to anemia, platelet transfusions are required every time symptoms occur. This can improve their symptoms and prevent the anemia from becoming more and more serious. However, there will be some side effects or adverse reactions after each platelet transfusion. This must be discovered and corrected in time to avoid more serious consequences, such as complications such as urticaria.

There are two main types of adverse reactions to platelet transfusion.

(1) Platelet transfusion refractoriness (PTR), with symptoms such as chills and fever. The patient’s platelet count not only does not increase, but sometimes decreases.

(2) Platelet-mediated thrombocytopenia (PTP) usually occurs suddenly about a week after platelet transfusion. Most patients experience sudden onset of thrombocytopenia and purpura, with the main manifestations being petechiae, ecchymoses, and mucosal bleeding. In severe cases, there are visceral and intracranial hemorrhages, which may last for 2 to 6 weeks. The vast majority of patients are women with a history of transfusion or pregnancy.

Concentrated platelets have the function of stopping bleeding; they are suitable for bleeding caused by thrombocytopenia. Platelets prepared in a single bag must be transfused on the same day; platelet concentrates prepared in multiple packages are stored in PVC plastic bags with an expiration date noted on the bag. They can be stored for 1-3 days at 22±2°C on a flat bed oscillator (60 times/min) and for 5-7 days in special platelet bags.

During infusion, transfusion reactions should be closely observed and handled promptly to prevent fever from causing platelet consumption. For mild allergic reactions such as systemic itching, erythema, urticaria, and angioedema, close observation should be conducted, the infusion rate should be slowed down, and antihistamines or steroids should be administered orally or intramuscularly. For severe allergic reactions, stop platelet transfusion immediately, keep the intravenous channel open, and inject 0.5-1 mg of epinephrine subcutaneously for those with bronchospasm. For those with laryngeal edema, perform endotracheal intubation or tracheotomy immediately to avoid suffocation. For anaphylactic shock, active anti-shock treatment should be given.

Platelet transfusion in the setting of fever and non-immune platelet consumption can cause ineffective platelet transfusion.

The current means of preventing and reducing platelet transfusion reactions include the following:

(1) Patients who have developed PTP or PTR should undergo platelet (HLA) antibody testing;

(2) Cross-match test: select HLA and HPA compatible blood donors for apheresis platelet transfusion;

The platelet cross-matching (SEPSA) test method is used to select donor platelets that match the recipient's HPA type and HLA type;

(3) The amount and frequency of platelet transfusion vary depending on the condition. Generally, the half-life of platelets is 3 to 4 days. For adults, 10 units are usually taken each time (1 bag of single-donor platelets is 10 units). It is expected to increase the platelet count by 2.0 to 2.5×1010/L.