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.
- 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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