NHS Blood and Transplant (NHSBT) would like to draw clinicians’ attention to an improvement in the quality of platelets for neonatal transfusion.
Changes to neonatal platelet packs
Neonatal platelets are currently suspended in plasma (approximately 50 ml packs). Platelet pH falls progressively over storage and is a marker of quality, including in vivo platelet recovery and survival. Improved UK guidelines will require that 90% of neonatal platelet packs have a pH at or above 6.4 at expiry. To ensure this, from January 14th 2020 NHSBT will add a small proportion (approximately 13 ml per bag, 20% by volume) of Platelet Additive Solution (PAS) to neonatal platelet packs. This improves pH and other quality measures. PAS in plasma is already used for pooled platelets for adults and older children, and by some countries for neonatal platelets.
Implication for neonatal transfusion practice
A potential clinical implication of the change is a likely 20% reduction in the platelet dose transfused for a given volume. However, it is considered that a 20% reduction in dose will not be clinically significant, particularly for transfusions given as prophylaxis for non-bleeding neonates. In settings such as cardiac surgery where neonates may be bleeding and transfusion volume is less of a consideration, clinicians may choose to transfuse higher volumes by utilising the additional volume in the new neonatal platelet packs.
Note: neonatal platelet transfusion doses are relatively much higher than for adults – the commonly transfused platelet volume is between 10-20ml/kg for neonates (New et al, 2016 BSH guidelines), whereas it is approximately 2-4ml/kg for adult recipients transfused with a single pack (the standard dose for non-bleeding adults) of apheresis platelets.
In view of considerations around transfusion associated circulatory overload (TACO) it is suggested that neonatologists do not increase the transfused volume of the new platelet component to compensate for the 20% dilution in non-bleeding neonates.
For additional queries, please discuss with your Hospital Transfusion Team in the first instance. Alternatively, you can email Dr Helen New, NHSBT Consultant in Paediatric Transfusion Medicine.