Knowledge Check

Evaluate the appropriateness of platelet transfusion order for the following clinical scenario: 1 platelet unit is requested for a 63-year-old male with a history of alcohol-induced end stage liver disease with ascites who presents for paracentesis. His platelet count is 47 x 10⁹/L.

Appropriate

Inappropriate

This order does not seem appropriate. A platelet count of >20K/uL (20 x 10^9/L) is adequate for a minor procedure. However, a patient with liver failure may be coagulopathic and have increased bleeding risk, therefore appropriate assessment and monitoring is warranted.

Calculate the CCI after transfusion of a platelet unit in a 72-year-old male patient with acute myeloid leukemia status post-induction chemotherapy. His pre- and post-transfusion platelet counts are 8 and 18K/mL, respectively. His BSA is 1.6m².

What is the CCI?

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CCI= [(post-transfusion platelet count – pre-transfusion platelet count/mL) x BSA (m²)]/number of platelet transfused
If the number of platelet transfused is not provided on the platelet label, use 4 (x 10¹¹).
CCI = [(18,000-8,000) x1.6]/ 4
CCI=10,000 x 1.6/4 = 16000/4=4000
A CCI <7500 is considered inappropriate response to platelet transfusions.

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