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    Corrected Count Increment (CCI) for Platelet Transfusion

    Assesses adequacy of response to platelet transfusion.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients undergoing platelet transfusion.

    • Corrected count increment (CCI) is a measure of the expected increase in platelets following a platelet transfusion. The “count increment” refers to the increase in platelets following a transfusion. The “correction” is based on the patient’s size and the number of platelets transfused. 
    • Refractory = failure to achieve acceptable increase in platelet count following platelet transfusion on at least two occasions and no alternate cause for refractoriness such as fever, sepsis, DIC, bleeding, splenomegaly, or drug interaction (e.g. amphotericin B).
    • Response to platelet transfusion is typically measured within one hour. However, a sample collected 10 minutes after transfusion yields similar information and may be easier to obtain routinely. A post-transfusion platelet count can alternatively be taken at 20 hours.
    • CCI is a more accurate measure of refractoriness, as it adjusts for the number of platelets transfused and the patient's blood volume.
    • Can guide the decision to pursue platelets with improved compatibility (i.e., HLA-matched platelets).
    ×10³/µL
    ×10³/µL
    1-hour
    20-hour
    in
    lbs
    ×10¹¹ plts

    Result:

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    Next Steps
    Evidence

    Advice

    • When no compatible platelets can be found to transfuse to a patient with platelet refractoriness, alternative measures can be tried to stem or forestall hemorrhage, but these are of unpredictable benefit.
    • Administration of antifibrinolytic agents, such as ε-aminocaproic acid (Amicar), either intravenously or, in the case of gingival bleeding, as a mouthwash, may allow the clot that is formed to be sustained.
    • Consider baseline patient factors, including age, gender, height/weight, history of pregnancy, and previous transfusion.
    • Possible patient characteristics to be evaluated for each transfusion:
      • Administration of amphotericin, heparin, or γ-globulin.
      • HLA and/or PLT antibody status of the closest sample prior to the transfusion.
      • Presence of bleeding, fever, infection, transfusion reaction, splenomegaly.

      Formula

      CCI = count increment, per µL × body surface area (m²) / unit content

      Units (m²/µL) are usually omitted when reporting the result.

      Example:

      For an adult patient with a BSA of 2.0 m² whose platelet count rose from 5 × 109/L to 25 × 109/L after a platelet transfusion containing 4.0 × 1011 platelets:

      • CCI for above patient = (20 × 109/L × 2.0 m²) / 4.0 = 10,000

      Facts & Figures

      Interpretation:

      CCI at 1 hour

      CCI at 20 hours

      Interpretation

      >7,500

      >4,800

      Successful transfusion

      ≤7,500

      ≤4,800

      Repeat transfusion. Two CCIs below the cutoff indicate refractoriness.

      Content Contributors
      • Ronald George Hauser, MD
      • Christopher Tormey, MD
      • Alex Ryder, MD, PhD
      Content Contributors
      • Ronald George Hauser, MD
      • Christopher Tormey, MD
      • Alex Ryder, MD, PhD