Platelets in massive transfusion

[Hamhock]

Does anyone put platelets through a rapid transfusing system (like Level I)? Does anyone use a warmer without pressure? Does anyone use just a pressure bag (no warming)?

HH

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[Idiopathic]

im sure people do. my understanding is that platelets should be infused slowly and not through a warmer. the reason for the former is the relatively high risk of transfusion reaction and for the latter is the fact that the products infused may be less effective.

i think the warming devices recommend no platelets or cryo through the warmer

 

[OB1🤙]

I have no problem platelets through a warmer. Recent literature supports this practice.

I do try not to pressurize them though, but I don't think there's high-quality evidence that you can't.

Presumably when soldiers get whole blood through rapid infusers, the platelets don't stop working. Data from that arena would be interesting.

 

[Idiopathic]

I have no problem platelets through a warmer. Recent literature supports this practice.

I do try not to pressurize them though, but I don't think there's high-quality evidence that you can't.

Presumably when soldiers get whole blood through rapid infusers, the platelets don't stop working. Data from that arena would be interesting.

For me, my warm lines are usually fast lines. There is no need to infuse platelets fast, and in fact, this is where I have seen my platelet reactions, so I always like them to go in slowly. Thus, they are off the warmer. I think evidence suggests temperature over 43 celsius impairs function and our warmers are at 41 so again that shouldnt be an issue - but why chance it?

 

[Hamhock]

Presumably when soldiers get whole blood through rapid infusers, the platelets don't stop working. Data from that arena would be interesting.

Oh yeah, I didn't think about the military and whole blood. I'll look into it more.
Thanks,
HH

 

[Idiopathic]

why would that data have anything to do with pooled platelet transfusions? they go in room temperature, i would think warming them to body temperature would be fine but not sure about 41

 

[Hamhock]

why would that data have anything to do with pooled platelet transfusions? they go in room temperature, i would think warming them to body temperature would be fine but not sure about 41

I think HB was saying that whole blood (containing platelets, albeit relatively "diluted") goes through rapid transfusers frequently without apparent difficulty, so why should it not work in the civilian world?

Also, I don't think the products that go through infusers actually reach 41 degrees, but rather are closer to 37 degrees by passing by warmer temperatures, but I could be wrong.

HH

 

[OB1🤙]

That's what I was saying, yes.

I do ANH for the vast majority of my hearts, and I run the whole blood through a Hotline. Occasionally I squeeze some in, and it seems fine.

Whenever I'm giving a lot of yellow stuff, I'll make a separate line for platelets to let them drip in while I power in FFP and PRBCs.

http://www.ncbi.nlm.nih.gov/pubmed/23921655

 

[Idiopathic]

Whenever I'm giving a lot of yellow stuff, I'll make a separate line for platelets to let them drip in while I power in FFP and PRBCs.

yeah i dont get to give whole blood, and we dont use ANH. as i said before, my hot lines tend to be fast, and i dont like my platelets to run in fast. there is no reason at all to warm them, and there are manufacturer recommendations and belief structures (dognatic, perhaps) that suggest against it.

if all i had was a single IV and was giving platelets, id tolerate the warmer, or simply turn it off