From the Guidelines
Platelet transfusion is recommended when platelet counts fall below 10 × 10^9 cells/L or less in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia, as stated by the AABB guideline 1. The decision to transfuse platelets should be based on the patient's clinical context, including bleeding risk, medication use, and underlying cause of thrombocytopenia.
- For patients with therapy-induced hypoproliferative thrombocytopenia, 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.
- For patients having elective central venous catheter placement, the AABB suggests prophylactic platelet transfusion with a platelet count less than 20 × 10^9 cells/L 1.
- For patients having elective diagnostic lumbar puncture, the AABB suggests prophylactic platelet transfusion with a platelet count less than 50 × 10^9 cells/L 1.
- Hematology consultation should be considered when platelet counts are persistently below 50 × 10^9 cells/L without clear cause, or when managing complex conditions like immune thrombocytopenia, thrombotic thrombocytopenic purpura, or heparin-induced thrombocytopenia. The AABB guideline provides recommendations for platelet transfusion in different clinical scenarios, including therapy-induced hypoproliferative thrombocytopenia, central venous catheter placement, and diagnostic lumbar puncture 1.
- The guideline recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass, but suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction 1.
- The guideline also suggests that clinical judgment should be used about the need for platelet transfusion in patients requiring lumbar puncture with platelet counts in the range of 20 × 10^9 to 50 × 10^9 cells/L 1.
From the Research
Platelet Transfusion Thresholds
- The recommended indication for prophylactic transfusion is a platelet count of 10,000/microL 2
- In stable, uncomplicated patients, the risk of bleeding is similar until the platelet count falls to <5,000/microL 2
- However, many patients have clinical complications that necessitate transfusion at higher counts 2
Clinical Considerations
- Patients with inherited defects of platelet function or acquired defects such as due to drugs or uremia, the platelet count is usually normal and prophylactic transfusion is not recommended 2
- Transfusion may be helpful to treat serious bleeding in these patients 2
- In idiopathic thrombocytopenic purpura, platelet survival is short and transfusion is useful only for severe bleeding 2
Hematology Consult
- A hematology consult may be necessary for patients with complex clinical situations, such as those with multiple comorbidities or refractory thrombocytopenia 3, 4
- Romiplostim, a thrombopoietin receptor agonist, may be considered as a treatment option for patients with immune thrombocytopenia who have failed standard treatment 3, 5, 4
Platelet Transfusion Guidelines
- Platelet transfusion guidelines have been published, but practices are still heterogeneous and may lack recommendations or differ in platelet threshold recommendations in some clinical situations 6
- The guidelines partly recommend a platelet threshold of 10,000/microL for prophylactic transfusion, but may vary depending on the clinical setting 2, 6