Cancer patients need platelets every few days: How delayed transfusions can disrupt treatment

India’s progress against cancer is measured in earlier diagnosis, better therapies and improved survival rates. Health system strengthening toward those goals usually focuses on the big picture of health infrastructure and manpower availability, not subtle indicators of systemic robustness such as the supply of blood and blood components. Platelets, for example, cannot be manufactured and have a short shelf life, yet can be life-saving in patients undergoing chemotherapy, stem-cell transplants and cancer surgeries. 

A 2023 study of 1,745 patients across five Indian cities found low platelet counts in 16.01 per cent of patients on chemotherapy, rising to about 28 per cent among those with blood cancers within three months of treatment. When counts fall, chemotherapy may be delayed or doses reduced, so a shortage of platelets can quietly become a shortage of treatment.

Nowhere is this dependence greater than in haematological cancers, which account for 9.5 per cent of cancers in Indian men and 5.5 per cent in women. Through weeks of chemotherapy, patients may need platelet support every few days. For them, how platelets are collected matters as much as availability. The best option for such patients is single-donor platelets. 

A better-matched product

Single-donor platelets, or SDP, are drawn from one donor by apheresis. Random-donor platelets, or RDP, come from whole-blood donations, with multiple units required for an adult dose. RDP exposes a patient to multiple donors, a difference that can compound with repeated transfusions. For a patient transfused repeatedly, that difference can compound over time.

SDP’s main advantage is fewer donor exposures and potentially fewer opportunities for complications, particularly alloimmunisation, which can contribute to platelet refractoriness after repeated transfusions. In an Indian study of children with haematological cancers, platelet responses remained stable with repeated SDP transfusions but declined with RDP; 50 per cent of the RDP group became refractory, mostly from immune causes.

The same study found significantly better platelet count increments after SDP. A 2026 Indian comparison has also reported differences in post-transfusion platelet increments between SDP and RDP, although the broader evidence does not support describing SDP as universally superior for every patient.

The apheresis product can also have lower red-cell contamination than pooled platelets, particularly relevant for RhD-negative patients, and supports targeted options such as crossmatch-compatible or HLA-selected platelets for patients with suspected immune refractoriness. Donor safety is also better when plateletpheresis includes appropriate donor selection and monitoring. There is another reason to focus on the system rather than simply the product: platelets are a difficult component to stock.

Sufficiency is not the same as reliability

Even the best platelet product depends on a system that can supply it. India collects millions of blood units every year, but sufficiency on paper is not reliable access. In an analysis of 35,740 blood components, platelets had the highest discard rate at 8.27 per cent, with expiry accounting for 64.1 per cent of discards.

India needs to build a dependable platelet-donor ecosystem.

Apheresis is more resource-intensive than whole-blood collection, requiring machines, trained professionals, quality systems and reliable forecasting. It grew after the 2006-08 dengue epidemics, yet only a tenth of India’s nearly 4,000 blood centres offer it, mostly in bigger cities. The shortage is therefore as much about trained personnel and organised donor pools as equipment.

What needs to change

Apheresis should grow first in high-volume cancer and tertiary-care hospitals where demand is steadiest, then extend to Tier 2 and Tier 3 towns, with regional hubs sharing capacity where a full service in every hospital is unrealistic. Blood centres also need efficient, standardised collection, trained staff, and better forecasting and inventory management to reduce wastage.

India needs a much larger base of voluntary, repeat donors, drawn in through steady public awareness rather than crisis appeals. At our centre, we collect approximately 3,600 SDP units annually, substantially supported by regular voluntary donors, including Delhi Police personnel.

Delhi Police Jeevandaini Team members have donated repeatedly, with Ravindra Dhariwal alone contributing platelets 155 times, including many donations at RGCIRC. Their commitment shows how a structured donor pool can be a game-changer.

India would also benefit from standardised, India-specific guidance and better national data on plateletpheresis. A national apheresis registry could map capacity, repeat-donor availability and regional gaps. One donor can provide one therapeutic dose of platelets. One donation can help sustain a treatment journey. And a community of regular donors can transform platelet availability from an emergency scramble into a reliable part of cancer care.

India’s next phase of cancer care will depend not only on what happens inside oncology wards, but also on the transfusion systems that support them. Single-donor platelet apheresis is not the sole answer to India’s platelet needs, but for patients who require repeated and specialised platelet support, it is an important part of the solution.

The time has come to build the donor base, strengthen the apheresis network and create the systems needed to ensure that when a cancer patient needs platelets, the right component is available—not by chance, but by design.

(The author is a consultant & head, Transfusion Medicine (Blood Centre), Rajiv Gandhi Cancer Institute & Research Centre)

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.