Platelet Infusion Filter or Not?
Quick Platelet overview
Platelets are essential for adequate hemostasis and are transfused for platelet dysfunction or thrombocytopenia. Platelets are available as platelet concentrates, separated from 1 unit of whole blood by centrifuge from 6 to 10 donors.
Nagelhout 7th ed.p. 405-406
Alternatively, single-donor apheresis platelets are available for patients with alloantibodies but at an increased expense. Treating bleeding caused by thrombocytopenia or abnormal platelet function includes a platelet transfusion. In an average adult, transfusion of one platelet concentrate is expected to increase the platelet count (by approximately 5–10 × 103/μL). The recommended therapeutic dose is one platelet concentrate per 10 kg body weight. ABO incompatibility may lead to shortened survival of platelets and a small degree of hemolysis. Therefore, ABO matching is preferred, but it is not essential for transfusion. Indications for treatment with platelets include individuals with a platelet count less than 10 × 103 platelets/μL who are stable and not bleeding to prevent spontaneous bleeding. For those actively bleeding, the recommendation is to transfuse platelets if the level is less than 50 × 103 platelets/μL. [Nagelhout 7th ed.p. 405-406]
Miller: Miller’s Anesthesia 9th ed.p. 2137
Platelet transfusion should typically be reserved for clinically coagulopathic patients with a documented low serum level (<50,000 per high-power field). When the patient is in shock, however, and blood loss is likely substantial, platelets should be empirically administered in proportion to RBCs and plasma (1: 1: 1). Transfused platelets have a very short serum half-life. They should be administered only to patients with active coagulopathic bleeding. Platelets should not be administered through filters, warmers, or rapid infusion systems because they will bond to the inner surfaces of these devices, thereby reducing the quantity of platelets reaching the circulation.
Charles J. Coté et al.: A practice of anesthesia for infants and children 5th ed.p. 202
Platelets should be filtered only by large-pore filters (>150 µm) or leukocyte-reduction filters (if indicated). Micropore filters may absorb large numbers of platelets, diminishing the effectiveness of a platelet transfusion.
Collated by Michael Storm, DNAP, CRNA 2025