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.
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?Click for Answer
- 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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