From the Guidelines
Platelet transfusions are indicated for patients with thrombocytopenia or platelet dysfunction who are actively bleeding or at high risk of bleeding, with a primary threshold for prophylactic platelet transfusion of a platelet count below 10 × 10^9 cells/L or less, as recommended by the AABB guideline 1.
Indications for Platelet Transfusion
The indications for platelet transfusion can be summarized as follows:
- Prophylactic platelet transfusion for patients with therapy-induced hypoproliferative thrombocytopenia with a morning platelet count of 10 × 10^9 cells/L or less 1
- Platelet transfusion for patients undergoing invasive procedures, with higher thresholds recommended: 20 × 10^9 cells/L for central venous catheter (CVC) placement and 50 × 10^9 cells/L for lumbar puncture (LP) 1
- Platelet transfusion for patients with active bleeding, with the goal of maintaining platelet counts above 50 × 10^9 cells/L, or higher depending on the severity of bleeding
- Platelet transfusion for patients with qualitative platelet disorders, such as those induced by medications or congenital disorders, when bleeding occurs
Thresholds for Platelet Transfusion
The thresholds for platelet transfusion vary depending on the clinical scenario:
- 10 × 10^9 cells/L or less for prophylactic platelet transfusion in stable patients with therapy-induced hypoproliferative thrombocytopenia 1
- 20 × 10^9 cells/L for CVC placement 1
- 50 × 10^9 cells/L for LP 1
Dosing and Administration
The typical adult dose of platelet transfusion is one unit of apheresis platelets or 4-6 units of pooled platelets, which should increase the platelet count by approximately 30,000-50,000/μL 1.
Clinical Judgment
Clinical judgment should be used to determine the need for platelet transfusion in patients with platelet counts between 20 × 10^9 cells/L and 50 × 10^9 cells/L who require LP 1.
From the Research
Indications for Platelet Transfusion
The indications for platelet transfusion are based on the patient's risk of bleeding and the underlying cause of thrombocytopenia. The following are some of the indications for platelet transfusion:
- Prophylactic platelet transfusion is recommended for patients with a platelet count of less than 10,000/μL 2, 3
- Patients with a platelet count of less than 20,000/μL may also require prophylactic platelet transfusion if they have additional risk factors such as bleeding or planned invasive procedures 2, 3
- Therapeutic platelet transfusion is recommended for patients with active bleeding or a platelet count of less than 10,000/μL 4, 5
- Platelet transfusion may also be considered for patients with qualitative platelet disorders, such as inherited platelet disorders or those on antiplatelet therapy 5
- Patients undergoing cardiopulmonary bypass or with severe bleeding may also require platelet transfusion 2
Special Considerations
- In 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
- In patients with idiopathic thrombocytopenic purpura, platelet survival is short and transfusion is useful only for severe bleeding 2
- A more restrictive transfusion strategy may be justified in clinically stable patients who are at low risk for bleeding 3