What are the guidelines for platelet transfusion?

From the Guidelines

Platelet transfusions should be administered prophylactically to hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia and a platelet count of 10 × 10^9 cells/L or less to reduce the risk for spontaneous bleeding. This recommendation is based on a strong recommendation with moderate-quality evidence from the American Association of Blood Banks (AABB) guideline on platelet transfusion 1.

Key Recommendations

• The AABB recommends transfusing up to a single apheresis unit or equivalent, as greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective 1.
• Prophylactic platelet transfusion is suggested for patients having elective central venous catheter placement with a platelet count less than 20 × 10^9 cells/L, although this is a weak recommendation with low-quality evidence 1.
• Similarly, prophylactic platelet transfusion is suggested for patients having elective diagnostic lumbar puncture or major elective nonneuraxial surgery with a platelet count less than 50 × 10^9 cells/L, but these are weak recommendations with very-low-quality evidence 1.

Clinical Considerations

• Platelet transfusions are not recommended for routine prophylactic use in patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass, unless there is evidence of perioperative bleeding with thrombocytopenia 1.
• The effectiveness of platelet transfusions can be influenced by various factors, including the patient's underlying condition, the presence of bleeding or risk factors for bleeding, and the potential for transfusion reactions.
• Post-transfusion platelet counts should be monitored to assess the response to transfusion and guide further management.

From the Research

Guidelines for Platelet Transfusion

The guidelines for platelet transfusion are based on the patient's individual hemorrhagic risk and platelet count.

• Prophylactic platelet transfusions should be given when clinically indicated, considering the individual hemorrhagic risk 2.
• The standard recommendation is to transfuse platelets when the morning platelet count is less than 10,000/μL, or less than 20,000/μL if there are additional risk factors 2.
• For chronic thrombocytopenia, transfusion is recommended if the platelet count is less than 5,000/μL 2.
• Patients with acute leukemia may require a threshold value of less than 10,000/μL 2.
• Clinically stable patients who are at low risk for bleeding may be well served by a therapeutic, rather than prophylactic, platelet transfusion strategy 2.

Platelet Count Thresholds

The following platelet count thresholds are recommended:

• Less than 10 × 10^3 per μL for patients with a high risk of serious bleeding 3.
• Less than 50 × 10^3 per μL for patients who should adhere to activity restrictions to avoid trauma-associated bleeding 3.
• Less than 10 × 10^3/µL for prophylactic platelet transfusions in stable hematology/oncology patients 4.

Special Considerations

• Patients with inherited platelet disorders or those on antiplatelet therapy may require special consideration for platelet transfusion therapy 5.
• The timing of transfusion and inhibitor mechanism-of-action are key in determining therapeutic success in patients on antiplatelet therapy 5.
• A higher threshold and/or larger or more frequent platelet doses may be appropriate for patients with clinical features associated with an increased risk of bleeding 4.