New ‘PBM Column’ Focuses on Lowering Platelet Doses

AABB’s 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.?” 

In 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). 

Friedman 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.  

Furthermore, 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.  

While 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 vary widely. 

Additional PBM resources are available in AABB’s PBM Toolkit.