Use of platelets

• Thrombocytopenia more hazardous in neonates, so prophylactic transfusion if count <30 x 109/L.

• Reserve for children with marrow failure and counts <10 x 109/L otherwise:

- Only use in immune thrombocytopenia for life-threatening bleeding.

- Then use massive 'swamping' dose to overwhelm antibody.

- One dose (one paediatric platelet concentrate) contained in ~50mL 'fresh' plasma, available either from apheresis or buffy coat derived.

- Check increment 1h later if no clinical response.

- Care with volume overload.

- Must be administered within 2h of receipt on ward.

- Irradiate for immunosuppressed children.

- Refractoriness can arise due to alloimmune antibodies.

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