Being coerced

An elderly gentleman had a major abdominal surgery and the anaesthetist had ordered a bag of platelets on standby from the blood bank in case it was required during the surgery. Platelets need to be ordered in advance as they take time to be issued, thus having it on standby is a good idea.

The patient comes to intensive care for post-operative management. 2 days after the surgery, the blood bank rings up to ask the staff nurse looking after the patient whether we were going to use the bag of platelets as it will be expiring in 16 minutes. The staff nurse then asks me the same question.

Doc, there is a bag of platelet ordered. It will expire in 16 minutes. Are we using it?

At the moment, there is no indication for platelet transfusion. He is not bleeding, and his platelet count is 72.

The normal range for platelet count is 150-400 but as he was not bleeding, a transfusion is not indicated. Lots of people have thrombocytopaenia but are not transfused unless necessary.

But doc, the bag of platelet will be thrown away then. It cost 400 pounds. Can we not just transfuse since his platelet count is only 72?

No, I am not putting someone at risk for transfusion-related infections and anaphylaxis when it is not indicated.

A bag of platelet has a shelf-life of only 5 days due to the preservatives used in it. Once it has expired, it will be thrown away, which I agree, is a pity. However, this patient did not need the transfusion. I was not going to risk my medical license to give someone a blood product which was not needed but has the added risk of transfusion-related infections.

The staff nurse was not happy with me after that but I was not bothered. She was not the one signing for the blood product. I was, and no way was I going to be coerced into doing so.

Admittedly, the blood bank was annoyed at us as well. Honestly, we had no idea the platelets was ordered by the anaesthetist. In an ideal system, the blood bank should have been called post-surgery to say that the platelets were no longer needed so that it can be re-issued to someone else. In an ideal system....