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LoPAG Platelets in London
Rachel Moss May 2013
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Platelets in London are harder to get than a table at
The Ivy!
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In the beginning we had graphs and the Blood Stocks Management Scheme data
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Platelet issues from NHSBT March 2001 - July 2012
28% increase in platelet issues
Greatest change over 5 years (‘07-’12) and still rising
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0
10
20
30
40
50
60
70
Ma
r-09
Ma
y-09
Jul-0
9
Se
p-09
Nov-0
9
Jan-1
0
Ma
r-10
Ma
y-10
Jul-1
0
Se
p-10
Nov-1
0
Jan-1
1
Ma
r-11
Ma
y-11
Jul-1
1
Se
p-11
Nov-1
1
Jan-1
2
Ma
r-12
Ma
y-12
Jul-1
2
000s
Platelets RTC
EMEELONNENWSCSECSWWMYH
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LoPAG had arrived
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LoPAG Proposal That all hospitals look at local laboratory and
clinical practices that could help to reduce platelet usage by 10%
If London RTC hospitals achieved this it would improve NHSBT stocks and hence availability
It would have a huge impact nationally because London RTC hospitals use more than any other RTC
Every hospital nominate a platelet champion to take the initiative forward
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LoPAG Plan
Email every RTC member and ask for a Platelet Champion from their transfusion team
Set out 10 Top Tips Offer BSMS VANESA training if wanted The platelet champion would link in with LoPAG LoPAG hoped to learn of more good practice
ideas to be shared amongst champions LoPAG to offer support and resources for
transfusion teams if needed
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10 Top Tips
1. Should your hospital stock platelets? 2. Could your hospital share platelets with another
local hospital? 3. Could your hospital introduce a locally defined
and agreed dereservation period for platelets allocated to a named patient?
4. Consider swapping long-dated platelets for short-dated ones
5. Consider using different ABO group platelets in adults who are bleeding
Jan 2012
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10 Top Tips
6. Consider using RhD positive platelets in adult males who are bleeding
7. Introduce the National Blood Transfusion Committee Indication Codes for platelets so that any requests outside the accepted criteria can be reviewed if appropriate
8. Double-dose platelets are not indicated in most situations – ‘why use two when one will do?’
9. Review the timeliness of platelet counts or other tests used to inform the decision to prescribe platelets.
10. Work at it – share practice with colleagues in other hospitals – and celebrate success!
Jan 2012
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LoPAG Survey
6 months after Top Ten Tips sent out
Survey sent to Platelet Champions Main premise asking if they do any
of the suggested tips and if so how/why
Results fed back to champions at Platelet Champions Day
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Does your hospital hold “stock” platelets?
0
5
10
15
yes no
Do you share platelets with other local hospitals? 0
5
10
15
yes no
Do you have a defined dereservation period for platelets allocated to a named patient?
0
5
10
15
yes no
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De-reservation period
4 hours 2
12 hours 1
24 hours 3
48 hours 3
24-48 hours 1
Do you have a defined dereservation period for platelets allocated to a named patient?
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Champions Day – Nov 2012
09:30-10:00 Registration & coffee All
10:00 – 12:30: the classroom sessions
10:00 – 10:05 Welcome and introduction Rachel Moss LoPAG Chair
10:05 – 10:45 Back to basics – what does a platelet actually do? Andy Miller Senior Scientific Officer
NHSBT
10:35 – 11:15 Platelets – it’s the special treatment needed Delordson Kallon NHSBT
11:15 - 11:45 TEG and Platelet mapping – how it works and how it reduces use Oliver Pearson, Product Specialist , Haemonetics
11:45 - 12:30 LoPAG Survey results – what did we learn? Carol Cantwell and LoPAG Steering group
12:30 – 13:30 Lunch All
13:30 – 16:00: the interactive sessions
13:30 – 14:30 Platelet Training Packs – developing a pack to take back to base Workshop
14:30: 14:45 Comfort break All
14:45 – 15:45 Indication Codes – do we use them and what do they bring to the decision to transfuse?
Workshop
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Platelet Champions Tool Kit
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Back to basics – what does a platelet actually do?
Uploaded to You Tube Title = Platelets the basics: given by Andy
Miller London RTC http://www.youtube.com/watch?v=PXj5Imd8avs
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Platelet App
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Double Dose Platelets
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Manchester Platelet Decision Chart
1
BONE MARROW FAILURE
3 IMMUNE
ITP / PTP / NAIT
2
SURGICAL/ CRITICAL CARE PATIENT
CHRONIC
PLATELETS <10 ?RISK FACTORS
INVASIVE PROCEDURE
DIC WITH
BLEEDING
PLATELET DISORDER
(1° / 2°)
MASSIVE TRANSFUSION
MAJOR LIFE THREATENING
HAEMORRHAGE
REMEMBER
• DOCUMENT INDICATION AND PRE COUNT (NOTES AND REQUEST FORM) • DOUBLE DOSE PLATELETS SHOULD NOT BE USED ROUTINELY
REQUEST FOR >1 DOSE FOR PROPHYLAXIS SHOULD BE CHALLENGED (Query with Transfusion Consultant Dr. Pendry)
• PRE AND POST PLATELET COUNT • IF NO INCREMENT CONSIDER REASONS FOR REFRACTORINESS
YES
PLATELETS ARE APPROPRIATE
NAIT
YES REVERSIBLE
NOT
INDICATED
Thanks to Dr Kate Pendry & team
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DIC
PLATELET DISORDER
NEONATES AND CHILDREN Keep Platelets above
STABLE PRE-TERM TERM INFANT >20 SICK PRE-TERM / TERM INFANT >30 NAIT (NEONATAL ALLOIMMUNE THROMBOCYTOPENIA) >30
SEVERE MUCOSITIS, LOCAL TUMOUR INFILTRATION PLATELET COUNT LIKELY TO FALL TO < 10, ANTICOAGULATION THERAPY >20 SEVERE HYPERLEUCOCYTOSIS OR DIC WITH INDUCTION THERAPY >40 DIC (DISSEMINATED INTRAVASCULAR COAGULATION) >20
ECMO >100 LUMBAR PUNCTURE >40
ADULTS Keep Platelets above NOT INDICATED
>10
LP / CVL INSERTION / TRANSBRONCHIAL / LIVER BIOPSY / LAPAROTOMY >50 EPIDURAL >80 EYE / CNS SURGERY >100
NO COMPLICATION >75 WITH HEAD INJURY / COMPLEX TRAUMA >100
WITH BLEEDING >75
INHERITED ANTI-PLATELET AGENTS (ASPIRIN / CLOPIDOGREL), CARDIOPULMONARY BYPASS, OTHER ACQUIRED PLATELET DEFECT
ROUTINE PROPHYLAXIS FOR NEONATES
PROPHYLACTIC USE FOR CHILDREN WITH RISK FACTORS
PROPHYLACTIC PROCEDURE
CHRONIC BONE MARROW FAILURE
REVERSIBLE BONE MARROW
INVASIVE PROCEDURES
MASSIVE TRANSFUSION
DIC
PLATELET DISORDER
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LoPAG
Achieved Working group of RTC Top 10 tips Resources available Top 10 tips survey results Champions Day Talk on You Tube LoPAG talks – TP day,
SNBTS HoT SIG May 2013
Future Plans Platelet education pack Summer Champions
newsletter LoPAG Day for SpRs Repeat Champions
Survey and day 2014
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Acknowledgements LoPAG members
Dr Kate Pendry
Andy Miller
BSMS Steering Group
Platelet Champions