October 11, 2023
Transfusion Safety and Patient Blood Management (TS/PBM) Subsection recently
released the latest article in its “PBM Column” series, “Lowering the Standard Dose of
Platelets: Is the Timing Right for the U.S.?”
this complimentary resource, Mark T. Friedman, DO, from NYU Langone Health and
NYU Grossman Long Island School of Medicine explores the possibility of
lowering the standard dose of platelets used in the United States. The dose in
the U.S. (3.0 x 1011
platelets per apheresis unit) has remained unchanged for more than 50 years,
Friedman notes, and is higher than the dose used in Canada and most European
Union nations (which range from 2.0 to 2.5 x 1011
per apheresis unit).
begins with a discussion of the potential benefits of lowering the platelet
dose. This includes research that suggests lowering the platelet dose could
boost the platelet supply by up to 23% without changing collection procedures
by increasing split product rates (i.e., double and triple collections),
potentially helping to alleviate shortages. However, the column raises concerns
about potential compromises in transfusion safety and donor comfort,
particularly associated with triple collections.
Friedman notes that current bacterial risk control strategies such as
large-volume delayed sampling platelets or pathogen-reduced platelets may
result in increased collections of low-yield (i.e., less than 3.0 x 1011/unit)
apheresis platelets. Research suggests that increasing use of these lower-yield
products may not correlate with increased transfusion rates as seen in France
and Switzerland, though could lead to shorter intertransfusion intervals and
increased workloads for staff in the U.S.
switching to a lower platelet dose in the U.S. has many strong proponents,
Friedman acknowledges the need for more research and suggests that lowering the
dose may not happen in the near future. He also discusses the challenges of
convincing clinicians to accept lower platelet doses, as clinical practices can
Additional PBM resources are available in AABB’s PBM Toolkit.