From the Guidelines
Platelet transfusions are not typically given at a platelet count of 37 × 10^9/L, as this is generally considered too high to warrant transfusion in most clinical scenarios. A platelet count of 37 × 10^9/L is considered low (thrombocytopenia) but usually not low enough to warrant a platelet transfusion in most clinical scenarios, according to the AABB guidelines 1. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding 1. Transfusions at a platelet count of 37 × 10^9/L would generally only be considered if the patient is actively bleeding, about to undergo an invasive procedure, or has additional risk factors for bleeding. Some key points to consider include:
- The AABB recommends a strong threshold for transfusion at a platelet count of 10 × 10^9 cells/L or less 1
- Higher thresholds (up to 50 × 10^9 cells/L) are sometimes used before certain surgeries or procedures, such as elective central venous catheter placement, diagnostic lumbar puncture, or major elective nonneuraxial surgery 1
- The decision to transfuse platelets should be based on the patient's individual clinical condition and risk factors for bleeding, rather than a single platelet count threshold 1. For most stable patients without bleeding, physicians typically monitor platelet counts in this range rather than transfusing, as this approach helps avoid unnecessary exposure to blood products and their associated risks, including allergic reactions, transfusion-related lung injury, and alloimmunization.
From the Research
Platelet Transfusion Guidelines
- The decision to transfuse platelets is typically based on the patient's platelet count and clinical condition 2, 3, 4.
- According to the study published in the American Family Physician, platelet transfusion is recommended when patients have active hemorrhage or when platelet counts are less than 10 × 10^3 per μL 2.
- Another study published in Transfusion Medicine Reviews suggests that the risk of bleeding is unusual unless the platelet count is ≤5 × 10^3/μL, and that prophylactic platelet transfusions may not be necessary at higher platelet counts 3.
- The optimal use of prophylactic platelet transfusion remains uncertain in many clinical scenarios, and more research is needed to define the optimal role for prophylactic transfusion 4.
Platelet Count Thresholds
- A platelet count of 37 × 10^3 per μL is below the general threshold for prophylactic platelet transfusion, which is typically around 10 × 10^3 per μL 2, 3.
- However, the decision to transfuse platelets at a count of 37 × 10^3 per μL would depend on the individual patient's clinical condition and risk factors for bleeding 2, 3, 4.
- Some studies suggest that therapeutic platelet transfusions may be more effective than prophylactic transfusions in controlling bleeding, and that the focus should be on providing aggressive platelet therapy for active bleeding rather than transfusing platelets prophylactically 3.