Emergency Platelet Transfusion Protocol

For patients who are refractory to standard platelet transfusions because of ITP or alloimmunization

This protocol places severe demands on blood product resources. Hematology consultation is mandatory before using the protocol for non-hematology patients

Indications: Severe thrombocytopenia, refractory to platelet transfusion, and at least one of the following:

1. Severe or life threatening bleeding

2. Urgent need for invasive diagnostic procedures

3. Urgent need for surgery

4. Severe thrombocytopenia (expected duration at least 7 days) after high-dose chemotherapy (HLA-matched or crossmatched platelets should be tried first)

Protocol:

IV IgG

Dose: 1 gram/kg/day x 2 days, given as continuous infusion

example: 72 kg person gets 72 grams per 24 hours (3 grams/hour) x 48 hours, total 144 grams. Please note this is EXTREMELY EXPENSIVE!!

Platelets

Apheresis platelets given as a continuous drip at the rate of one unit every four hours. This is equivalent to one unit of random donor platelets per hour.

Start concomitantly with IV IgG and run for 72 hours

 Platelet count typically rises to 100k in 1-2 days and may remain elevated for 3-7 days.

Reference: Spahr and Rodgers. Treatment of immune-mediated thrombocytopenia purpura with concurrent intravenous immunoglobulin and platelet transfusion: A retrospective review of 40 patients. Am J Hematol 2008; 83:122