Platelets, which are also known as thrombocytes, are blood cells which are crucial for your body’s ability to stop bleeding (blood clotting).
During surgery, the ability to stop excessive bleeding is especially important. The average platelet range per microliter is 150,000 to 450,000; your body’s platelet levels can be determined with a blood test.
A low platelet count, known as thrombocytopenia, isn’t much of a concern for most surgeries unless your level falls below 50,000 per microliter.
Platelet levels that fall around 100,000 per microliter are considered to be a mild form of thrombocytopenia, but won’t typically require treatment and isn’t a major concern for surgery.
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Abnormal platelet functions can be caused by taking drugs that are commonly used such as aspirin, along with other anti-inflammatory drugs such as Plavid (clopidogrel) and ibuprofen.
If you take any medications such as these on a regular basis, your surgeon will most likely ask you to stop taking them leading up to surgery. Appropriate timing should be checked with your doctor.
If any of these drugs or other non-platelet anti-clotting drugs such as warfarin (Coumadin) cannot be stopped safely for prior to surgery, then perhaps alternatives or a platelet transfusion should be considered.
If you have a history of excessive bleeding or a lower platelet count, your physician will likely recommend a referral to a platelet specialist such as a hematologist for an overall recommendation or further workup to determine the best course of action.
Read More: What happens when platelets are low?
Guidelines for platelet transfusion
These following guidelines support doctors and physicians in their decisions clinically related to platelet transfusion products.
Platelet products are not intended to be a structured prescription for care and shouldn’t replace the overall need to consult with experts in transfusion medicine.
Platelet transfusion decisions should be made by the judgment of your primary or surgical physician after a cautious review of your clinical situation and condition.
The overall goal is to ensure appropriate uses of donor (allogeneic) blood supplies and optimize patient outcomes.
General considerations for a platelet transfusion must include an established cause for the thrombocytopenia.
This is especially critical because platelet transfusions should not be suggested in every case and may very well be contraindicated under specific conditions, such as hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and heparin-induced thrombocytopenia.
When a cause has been determined, the decision to move forward with a platelet transfusion should not solely be based on a patient’s high or low count of platelets. The decision to undergo a transfusion in the case of surgery should be based on the need to treat or prevent bleeding.
Platelet transfusion should only be performed after the risks have been considered and the benefits outweigh the potential risks.
Besides the general risks of a transfusion, it should be kept in mind that alloimmunization of platelets and bacterial contamination are increased with a platelet transfusion.
In order to minimize the need for the transfusion of platelets, the situation should be diagnosed and treated, antiplatelet and anticoagulants should be discontinued prior to surgery, along with the review of other coagulation parameters.
If a platelet transfusion is made, the reasons should be accurately and clearly documented in the patient’s chart, along with any record used for the administering and order of or the platelet transfusion.
Platelets should be stored with gentle agitation at between 20°-24° Celsius. Because they have a limited shelf life of 5 days, products are produced in short supplies.
Many hospitals routinely do not stock platelets, so transfusion laboratories or blood banks should be notified of any requirements. While various products do exist, here are the most common:
- Random-donor: Every platelet unit contains a minimum of 55 x 10^9 platelets that are suspended in 40 to 70 mL of plasma
- Single-donor: Each platelet unit contains a minimum of 300 x 10^9 platelet that are suspended in between 200 and 400 mL of plasma
Platelet product response
Generally, a single unit from a random-donor should increase patient platelet count by 5 x 10^9 per liter. Patient response to transfusion should be analyzed between 15 minutes and an hour following the transfusion.
Refractoriness is a failure to achieve the desired and expected CCI after two consecutive transfusions have been given to the patients. Patients who have been determined as refractory should be further assessed by a hematologist or a transfusion medicine specialist.
Most studies reveal that anything above a 50,000 platelet level for surgery is safe.
However, if you have been diagnosed with a low platelet count, then you should talk with your primary care physician for a full health review and clearance to undergo surgery.
Remember that cases of cosmetic surgery should never be considered an urgent matter, and the most important way to prepare for surgery is to take every precaution deemed necessary to assure a safe and successful surgical outcome.