Patient Care

New Guidelines for Platelet Transfusions in Adults


 

Clinical question: What is the recommended approach to platelet transfusion in several common clinical scenarios?

Background: The AABB (formerly American Association of Blood Banks) developed these guidelines from a recent systematic review on platelet transfusion.

Synopsis: One strong recommendation was made based on moderate-quality evidence. Four weak or uncertain recommendations were made based on low- or very low-quality evidence.

For hospitalized patients with therapy-induced hypoproliferative thrombocytopenia, transfusion of up to a single unit of platelets is recommended for a platelet count of 10x109 cells/L or less to reduce the risk of spontaneous bleeding (strong recommendation, moderate-quality evidence).

For patients undergoing elective central venous catheter placement, platelet transfusion is recommended for a platelet count of less than 20x109 cells/L (weak recommendation, low-quality evidence).

For patients undergoing elective diagnostic lumbar puncture, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).

For patients undergoing major elective non-neuraxial surgery, platelet transfusion is recommended for a platelet count of less than 50x109 cells/L (weak recommendation, very low-quality evidence).

For patients undergoing cardiopulmonary bypass surgery, it is recommended that surgeons not perform routine transfusion of platelets in non-thrombocytopenic patients. For patients who have peri-operative bleeding with thrombocytopenia and/or evidence of platelet dysfunction, platelet transfusion is recommended (weak recommendation, very low-quality evidence).

There is insufficient evidence to recommend for or against platelet transfusion in patients with intracranial hemorrhage who are taking antiplatelet medications (uncertain recommendation, very low-quality evidence).

Citation: Kaufman RM, Djulbegovic B, Gernsheimer T, et al. Platelet transfusion: A clinical practice guideline from the AABB. Ann Intern Med. 2015;162(3):205-213.

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