Administration

1. Platelets should be stored at 22°C. They must NOT be refrigerated. They should be transfused as soon as they arrive on the ward.
2. The standard dose of platelets will be 10ml per Kg. This should raise the platelet count by approximately 110 x 10⁹/l.
3. The appropriate volume of platelet concentrate should be drawn into a new plastic syringe using a new filter suitable for administration of blood components (170 micron).
4. The platelet concentrate should be infused over 30-60 minutes, mixing the syringe from time to time to avoid platelets settling out.

Blood Components Available for Platelet Transfusion of Neonates

New Zealand Blood Service provides a dedicated platelet concentrate for neonatal use. This is derived from an apheresis donation which has been split into 4 components using sterile systems.

All blood components provided by NZBS are leucodepleted at source. Statistical process control is used to ensure that greater than 99% of components will have a level of <5 x 10⁶ WBC per unit (95% confidence).

Platelet Neonatal Apheresis Leucocyte Depleted

Specification

• Shelf life 5 days
• Volume 45-100ml (usually 50ml)
• Platelets ≥0.6 x 10¹¹
• CMV antibody negative
• Blood Group O Rh(D) negative

A detailed datasheet on this component is available on the NZBS website (www.nzblood.co.nz)

Special Considerations When Transfusing Neonates

a. Cytomegalovirus infection

• Infants weighing less than 1.5kg, those with immunodeficiency and stem cell transplant recipients are at greatest risk of transfusion transmitted CMV disease. These infants should receive CMV antibody negative blood components.

• Blood components produced for neonatal use by NZBS are normally CMV antibody negative. In certain specific settings this may not however be possible.
• When CMV antibody negative components are not available then the transfusion of leucodepleted components is an acceptable alternative

b.      Irradiation of Blood Components

• Detailed Guidelines on irradiation of blood components produced by the Australian and New Zealand Society for Blood transfusion (ANZSBT) can be obtained on the NZBS website (www.nzblood.co.nz)
• Irradiation is used to reduce the risk of Transfusion associated Graft versus Host disease (TA-GvHD).
• Irradiated components are required for:
  • Infants with known or suspected immunodeficiency disorders
  • Infants who have received intrauterine transfusions
  • Infants transfused with directed donations (from family relatives)
  • Exchange transfusion where irradiation will not unduly delay transfusion

Routine irradiation of cellular blood components outside of the above is not required by current international guidelines.

c. Volume restriction

• Infants who require transfusion but who may be unable to tolerate the volume required for standard neonatal products may benefit from reduced volume platelet concentrates. These are manufactured on demand and require approval from an NZBS Transfusion Medicine Specialist.

d. Neonatal Alloimmune Thrombocytopenia (NAIT)

• When NAIT is suspected advice on diagnosis and management should be sought from an NZBS Transfusion Medicine Specialist. Where feasible, platelet support will be provided from HPA compatible donors. When this is not possible then washed maternal platelets may be required. 

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