Platelets are tiny cells in your blood that help to stop bleeding. Some cancers or cancer treatments can lead to low platelets. When you have a platelet transfusion you are given platelets from carefully screened donors.
Platelets develop from stem cells in the bone marrow (the spongy material inside the bones). They are then released from your bone marrow into your blood and travel around your body in your bloodstream. They form clots to help stop bleeding.
Platelets usually survive for 7 to 10 days before being destroyed naturally in your body or being used to clot the blood.
Your doctors may recommend a platelet transfusion if your platelet count is low. Your platelet count may drop if your bone marrow is not working normally. This may be because you have cancer, leukaemia or a blood disorder.
Treatment with chemotherapy, targeted therapies and sometimes surgery can also affect your platelet count. A type of radiotherapy called total body irradiation (TBI) can also affect your bone marrow and platelet count.
You will have regular blood tests during your cancer treatment to check the numbers of blood cells in your blood, including your platelets. This test is called a full blood count (FBC). The normal platelet count in an adult is between 150 to 400 x 109/l . The risk of bleeding increases as the platelet count drops below this.
Signs of a low platelet count include:
- bleeding gums
- heavy periods
- tiny blood spots under the skin (petechiae).
You should tell your doctor straight away if you notice any of these symptoms.
Serious bleeding is rare and usually only happens if the platelet count is very low (below 10) or below 30 if you also have a high temperature. Your body uses up platelets faster if you have a high temperature.
You may also have a platelet transfusion if your counts are low before a procedure where there is a risk of bleeding. This includes surgery, a lumbar puncture or bone marrow aspiration. The platelet transfusion will reduce the risk of any bleeding during or after the procedure.
If you are at home with a high temperature and think that your platelets could be low, contact the hospital on the emergency numbers you have been given.
Before you have a transfusion, your doctor will explain why it is being given. You will usually be asked to sign a form saying that you give your permission (consent) for the hospital staff to give you a platelet transfusion. No medical treatment can be given without your consent.
Platelets are given by a drip (infusion) into one of your veins. A nurse will put a short, thin tube (cannula) into a vein in your arm or hand. This is then connected to a drip. If you have a central line or PICC line in place for other treatments, your nurse can connect this to your drip instead.
The transfusion usually takes 15 to 30 minutes. You may have the infusion at an outpatient clinic, in a day unit or as an inpatient.
The transfusion increases the number of platelets in your blood straight away. For some people, the benefits may only be temporary and they may need more transfusions.
Reactions to the platelets
During the transfusion, you will have your temperature, pulse and blood pressure checked regularly by the nurses. This is to make sure you are not having a reaction. Common reactions can be:
- a rise in temperature
- a skin rash.
The nurses will check you for any reactions. They’ll stop the transfusion and quickly treat any symptoms. Tell your nurse straight away if you feel unwell during your transfusion.
Contact the hospital if you have any problems after you get home.
Becoming resistant (refractory) to platelets
Rarely, if you have had lots of platelet transfusions, they might stop working as well for you and your platelet count may not improve after a transfusion. This is called becoming ‘refractory’ or resistant to platelets. If this happens, you will have tests to find the cause. You may be given platelets that are better matched to your own.
Some people worry that the platelets they are given may be infected by disease. People who donate blood or platelets are carefully screened for infections or viruses such as hepatitis or HIV. This is to make sure the donations are as safe as possible. All donated platelets are tested in the laboratory for infection. The risk of being given infected platelets is very small.
If you have any concerns about receiving a platelet transfusion, talk to your doctor or specialist nurse.
Irradiated blood products
If you have Hodgkin lymphoma or have had certain chemotherapy drugs, certain targeted therapies or after a stem cell transplant, any platelet transfusions you have must be treated first with radiation (irradiated). Your doctor will tell you if this applies to you.
Having irradiated blood products lowers the risk of the donated cells reacting against your own. The radiation won’t damage the platelets or make you radioactive. Your doctor will record in your medical notes if you should only have irradiated blood products.
They will also give you a special card to carry in case you’re treated at another hospital. Keep this card with you at all times and remind your hospital team that you need irradiated blood or platelets.