Patient Safety Considerations for Platelet Transfusions

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In pets with life-threatening bleeding disorders, platelet transfusions can be an effective method for improving outcomes¹; however, similar to transfusions with other blood products, platelet transfusions are not without risk, including tick-borne disease, sepsis, and immune-mediated reactions.

The Need for Hemovigilance

Hemovigilance describes the surveillance procedures that comprise the entire blood transfusion chain (ie, from donation to transfusion and follow-up) and are designed to minimize the risks associated with transfusions.²

In human medicine, platelet transfusions are associated with an increased risk for bacterial infection and sepsis as compared with other blood products.^3,4 The overall incidence of bacterial contamination in fresh room-temperature stored platelet concentrate is ≈1 in 5,000.⁴ Although there are no published data on platelet transfusion risks in dogs, transfusion risks in dogs are considered to be similar to those observed in humans.

Additional Risks Associated with Platelet Transfusions

Febrile nonhemolytic transfusion reactions have been reported in ≤30% of humans receiving platelet transfusions.⁵ The risk for reaction can be significantly decreased through leukoreduction, a processing technique that removes all WBCs from the transfused product and is incorporated in the StablePlate RX. With leukoreduction, febrile nonhemolytic transfusion reactions are observed in <10% of human patients receiving platelet transfusions.⁶

Allergic reactions ranging from urticaria to anaphylaxis are also a potential risk of platelet transfusions and occur in ≤21% of humans receiving platelet transfusions.⁷ Minimizing plasma volume through platelet concentration and properly blood typing and screening plasma donors can lower this risk to 6% to 8%.⁸

Hemolysis can also occur in humans receiving platelet transfusions, especially in the case of blood type incompatibility, and these reactions may be fatal,^5,9 although these reactions are unlikely to occur in dogs due to a difference in lymphocyte antigen expression.

Do the Benefits of Platelet Transfusions Outweigh the Risks?

Although no transfusion is risk-free, platelet transfusions offer life-saving benefits in dogs with uncontrolled and/or life-threatening bleeding.¹⁰ To maximize the benefit:risk ratio, all transfusions should be performed with attention to hemovigilance and careful patient monitoring. The use of prescreened donors, pathogen inactivation technologies, leukoreduction, and the use of refrigerated, frozen, or lyophilized products are all methods that can help decrease the risk for transfusion reactions.