Blood Product Utilization Guidelines

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Platelet Transfusion Guidelines

Last update: March 20, 2020

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Standard transfusion thresholds

  • Platelet count < 10,000
    • Prophylaxis against bleeding in hospitalized adult patients
      • Patients with ITP or TTP should not receive platelets, unless life-threatening bleeding occurs
  • Platelet count < 20,000
    • Central venous catheter placement
    • Low-risk invasive procedures, including paracentesis, thoracentesis, transjugular liver biopsy, and lumbar puncture performed by interventional radiology
  • Platelet count < 50,000
    • Lumbar puncture, not performed by interventional radiology
    • Major active bleeding
    • Major surgery, including post-operative bleeding
    • High-risk invasive procedures, including renal or percutaneous liver biopsy
    • Acute promyelocytic leukemia (APL) patients
  • Platelet count < 100,000
    • Neurosurgery, intracranial head bleed
    • ECMO or cardiac bypass patients
  • Patients on aspirin with severe bleeding
    • 1 unit of platelets may be given.
  • Patients on Plavix (clopidogrel) with severe bleeding
    • 2 units of platelets may be given.
  • A single unit of platelets is the standard for transfusion, with the exception of patients on Plavix with bleeding.
    • After giving 1 unit, check the platelet count 15 minutes-1 hour after transfusion, and re-evaluate for on-going bleeding, if a second unit is needed to achieve the platelet goal.

**In patients with severe thrombocytopenia, splenomegaly, or liver disease, a particular platelet goal may not be achievable, and goals will need to be lowered. Clinicians may be asked to obtain a TEG to assess whether there is evidence of adequate platelet function, and/or hang a platelets right before a procedure and proceed**

Emergency critical shortage transfusion thresholds

  • During critical times of blood product shortage, the platelet transfusion thresholds will be lowered.
  • Every platelet unit ordered may be triaged by transfusion medicine.
  • Outpatient transfusions may be stopped.
  • Units may be split, and ½ units provided.
  • Platelet transfusions may be limited to only patients with life-threatening bleeding if necessary, to preserve a limited platelet inventory.


  • Kaufman RM et al. Platelet Transfusion: A Clinical Practice Guideline from the AABB. Ann Intern Med. 2015; Feb 03; 162(3):205-13 


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