A colleague in Northern California wants to know if anyone can share credible evidence regarding contraindications for transfusing units of platelet concentrates or Plateletpheresis products during a dialysis treatment? The Transfusion Service at her facility is of the opinion that it is not appropriate to transfuse a patient with platelets during dialysis, due to a concern that platelets may adhere to the dialysis equipment and/or tubing. This question was recently brought up when they received a request to transfuse platelets during the dialysis of a patient. The dialysis equipment manufacturer was contacted and stated that with their equipment, they were unaware of contraindications for transfusing platelets through the dialysis machine. According to the RN in charge of the dialysis manufacturer's machines, if platelets were to be transfused, they would not be transfused through the machinery, but rather through tubing that leads directly into the patient. The inquiring colleague concludes by asking, "I would be interested in knowing the practice at other hospitals."

Editor's comment: The following references, while old, may be of interest to this discussion:

• Vicks SL, Gross ML, Schmitt GW. Massive hemorrhage due to hemodialysis-associated thrombocytopenia. Am J Nephrol. 1983 Jan-Feb;3(1):30-3.
• Docci D, Turci F, Del Vecchio C, Bilancioni R, Cenciotti L, Pretolani E. Hemodialysis-associated platelet loss: study of the relative contribution of dialyzer membrane composition and geometry. Int J Artif Organs. 1984 Nov;7(6):337-40.
• Hakim RM, Schafer AI. Hemodialysis-associated platelet activation and thrombocytopenia. Am J Med. 1985 Apr;78(4):575-80.
• Verbeelen D, Jochmans K, Herman AG, Van der Niepen P, Sennesael J, De Waele M. Evaluation of platelets and hemostasis during hemodialysis with six different membranes. Nephron. 1991;59(4):567-72.

The following comments have been received.

ADDENDA Oct. 10, 2003

1. A transfusion medicine physician in Sacramento is unaware of a contraindication to transfusing platelets during renal dialysis. He correctly points out that a patient's blood, with platelets, goes through the dialysis machine with minimal effect on the platelet count. However, he adds that if a patient truly needed a platelet transfusion during dialysis he would recommend that the platelets be transfused directly into the patient and not into the dialysis machine.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator