Platelet Transfusions

Therapeutic Platelet Transfusions

WHO Bleeding Scale

In general Grade 1 and 2 bleeds are considered to be due to the patients underlying WAS related thrombocytopenia.  Grade 3 and Grade 4 is more often caused by other factors such as trauma, medications, infection etc  In patients with WAS, platelet transfusions are usually indicated for bleeding that is greater than are equal to a WHO Grade II Bleed 6(World Health Organization).  However, each patient is presents with a unique set of circumstances and decisions to transfuse have to be considered on an individual basis.The general consensus is that platelet counts should be maintained over 50,000/ for acute bleeding and over 100,000/ in the event of multiple trauma or an intracranial bleed7.

Platelet transfusion may not always be effective in controlling the bleeding in these patients.  In the SPRINT Trial17, WHO bleeding grades decreased in only 21% of the transfusions.  Some patients may need a platelet infusion(a continuous drip of platelets) to help stop the bleed.  In the event  of an uncontrollable bleed, surgeons may perform an emergency splenectomy (verbal communication - Dr. Kurtzberg) in an attempt to increase the platelet counts and help stop the bleed.  Other clot promoting agents such as Recombinant Factor VII (Novo Seven) or aminocaproic acid or tranexamic acid may be used as adjuncts to help control the bleeding.