Platelet Transfusion Guidelines

Last update: March 20, 2020

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.

References

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

Disclaimer

These documents and content on this website are guidelines during the COVID-19 pandemic. Because new information is released rapidly, these documents can be updated or changed at any time. These documents are in no way to be considered as a standard of care and the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information in these documents is provided with no guarantees, accuracy, or timeliness. All content in these documents and website are for informational purposes only and do not constitute the providing of medical advice.