From the Guidelines
Platelet transfusion is suggested to maintain a platelet count above 100 × 10^9/L in patients with TBI, with an initial dose of four to eight single platelet units or one aphaeresis pack 1. Platelet decrease in TBI is a critical concern that requires prompt attention to prevent further complications. The management of thrombocytopenia in TBI patients involves regular monitoring of platelet counts, especially upon admission and during the acute phase of treatment. Key considerations in the management of platelet decrease in TBI include:
- Monitoring platelet counts regularly to identify thrombocytopenia early
- Administering platelet transfusions when counts fall below the recommended threshold of 100 × 10^9/L 1
- Using an initial dose of four to eight single platelet units or one aphaeresis pack for platelet transfusion, as suggested by recent guidelines 1
- Addressing underlying causes of thrombocytopenia, such as medication effects or disseminated intravascular coagulation (DIC)
- Continuously assessing platelet function, as it may be impaired even with adequate platelet counts. The goal of these interventions is to minimize the risk of bleeding and other complications associated with thrombocytopenia in TBI patients, ultimately improving morbidity, mortality, and quality of life outcomes.
From the Research
Platelet Decrease in TBI
- Platelet dysfunction is known to occur in patients with traumatic brain injury (TBI), and the correction of platelet dysfunction may prevent hemorrhagic progression in TBI 2.
- Studies have shown that patients with TBI develop platelet dysfunction, which most likely contributes to bleeding complications 3.
- The observed platelet dysfunction appears to involve the cyclooxygenase pathway, and thromboelastography with platelet mapping (TEG-PM) can be used to identify patients with a high risk of bleeding complications 3.
Correction of Platelet Dysfunction
- Platelet transfusions have been shown to correct platelet dysfunction and may improve survival in patients with severe TBI 4.
- Goal-directed platelet transfusions can improve clot strength and correct adenosine diphosphate inhibition in patients with severe TBI 4.
- However, the benefits of platelet transfusion in patients with moderate thrombocytopenia are not significant, and the indications for transfusion should be carefully considered in patients with moderate hematological abnormalities 5.
Transfusion Thresholds
- Transfusion thresholds for platelets should be at least 50,000/mm(3) for patients without and 100,000/mm(3) for patients with evidence of hemorrhage 6.
- Reversal of antiplatelet therapy with platelet transfusion is advisable only in patients with active bleeding, and tests for platelet function are helpful in determining an adequate platelet transfusion in these situations 6.
- The benefit of product transfusion should always be weighed against the risk of a transfusion-related complication, and patients should be closely observed for signs of volume overload and the development of transfusion-related acute lung injury 6.