Platelet Transfusion Guidelines

 Majority of platelet transfusions are prophylactic

 Avoid unnecessary usage– Safest transfusion is the one not given because it
is not needed.
 Prior to prescribing a platelet transfusion consider:
1. What is the indication for transfusion in this patient?
2. Are there any alternatives which could be used instead?
3. Is the patient aware of the benefits, harms and alternatives to a platelet transfusion?

Algorithm for reviewing requests for platelet transfusions

Is Patient
actively
No bleeding? Yes

Is patient under
Other risk factors MTP?
for bleeding?

Yes
No
No
Yes
Bleeding at critical Issue
sites/ major trauma, platelets in
Is patient posted Transfuse if platelet
multiple trauma, ratio of
for surgery? count is < 50,000/ l
severe bleeding 1:1:1 or
(WHO grade 3 or 2:1:1 as per
more) post cardio institutional
Yes No pulmonary bypass- policy
100,000/l

 Neurosurgery and Transfuse if platelet

Ophthalmic surgery- count is < 10,000/l
100,000/l Severe bleeding
 Other Major surgery- (WHO Grade 2), Mild bleeding
50,000/l Bleeding type of (WHO Grade I)
 Minor Surgery- DIC, Severe sepsis- - 30,000/ l
30,000/l
50,000/l

Transfuse platelets in
The flowchart
Consider patients of Immune
does not apply to
Tranexamic Acid Thrombocytopenic
patients of platelet
in patients with purpura (ITP),
functional
active bleeding Thrombotic
disorders or
or at risk for Thrombocytopenic
patients on
severe bleeding Possible alternatives
Purpura to
(TTP)platelet
or transfusion:antiplatelet drugs
unless Heparin Induced
contraindicated. Thrombocytopenia
(HIT) only if actively
bleeding
 Apply surface pressure after superficial procedures and correct surgical causes for
bleeding •

 Surgical patients expected to have at least a 500 ml blood loss (or >10% blood
volume in children), use tranexamic acid (TXA) unless contraindicated

 Trauma patients who are bleeding or at risk of bleeding, early use of TXA

 Severe bleeding replace fibrinogen if plasma concentration less than 1.5 g/L

 Anti-platelet agents - discontinue or if urgent procedure/bleeding use TXA if

risk/benefit would support

 Uraemia with bleeding or pre-procedure – dialyse, correct anaemia, consider

desmopressin

 Inherited platelet function disorders - specialist haematology advice required.

Consider desmopressin

 Chronic Bone Marrow Failure (BMF) with bleeding – consider TX

 Indications:
Treatment of bleeding due to:
• Thrombocytopenia
• Platelet function defects.
• Prevention of bleeding due to thrombocytopenia as in bone marrow failure.

 Contraindications:
 Absolute: Thrombotic thrombocytopenic purpura (TTP). British
Journal of
Haematology recommends platelet transfusion in cases of TTP only during life
threatening bleeds.

 Relative:
 Idiopathic autoimmune thrombocytopenic purpura (ITP).
 Untreated DIC.
 Thrombocytopenia associated with septicaemia, or in cases of
hypersplenism.

Transfusion triggers

Clinical condition Platelet transfusion triggers for

 prophylactic
transfusion
Reversible bone marrow failure where 10,000/μl in non‐bleeding, non‐infected
recovery is anticipated patient

Chronic bone marrow failure where No prophylactic platelet is

recovery is not anticipated recommended
Manage patient according to severity of
their
sign and symptoms.
Critical illness with no bleeding 10,000/ μl in non‐bleeding, non‐infected
patient

venous central lines 10,000/ μl

Lumbar Puncture 40,000/ μl

Insertion removal of epidural catheter 40,000/ μl

Major surgery 40,000/ μl.

Neurosurgery/ophthalmic surgeries 1 lac/ μl

Percutaneous liver biopsy 50,000/ μl

Renal Biopsy Avoid platelet transfusion because

infused
platelet will acquire a dysfunction similar
to
patient own platelets

consider desmopressin
Bone marrow aspirate, trephine biopsy, No prophylactic platelet required
peripheral
catheter insertion and cataract surgery

Severe bleeding (Massive transfusion) 50,000/ µl

Multiple trauma, traumatic brain injury or 1 lac/ µl

spontaneous intracerebral haemorrhage

Non severe bleeding 30,000/ µl

 DIC in presence of bleeding 30,000/ µl

• Neonate (including very pre-term) 25 x 109/L

• Neonate with NAIT (no family history of ICH)
25 x 109/L

• Preterm neonate with sepsis 25 x 109/L

• Neonate with NAIT (Family history of ICH)
50 x 109/L
• Lumbar puncture*
• Major surgery 40 x 109/l
• Neurosurgery 100 x 109/l
100 x 109/l
Procedures with low-risk of bleeding Not indicated

• Severe bleeding 100 x 109/L

References.

1. Estcourt L, Birchall J, Allard S, Bassey S, Hersey P, Kerr J, Mumford A,

Stanworth S, Tinegate H. Guidelines for the use of platelet transfusions.
British journal of haematology. 2016 Dec 23;176(3).

2. Shan Yuan, Zaher K. Otrock, Platelet Transfusion: An Update on Indications

and Guidelines,
Clinics in Laboratory MedicineVolume 41, Issue 4,2021,Pages 621-634, ISSN
0272-2712, ISBN 9780323795050.

3. Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG,
Gernsheimer TB, Ness PM, Brecher ME, Josephson CD, Konkle BA. Dose of
prophylactic platelet transfusions and prevention of hemorrhage. New
England Journal of Medicine. 2010 Feb 18;362(7):600-13.

4. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT,

Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD.
Platelet transfusion: a clinical practice guideline from the AABB. Annals of
internal medicine. 2015 Feb 3;162(3):205-13.