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Platelet transfusion

What's new

The American Association of Blood Banks (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) have released an updated guideline on platelet transfusion. The panel strongly recommends a restrictive over a liberal platelet transfusion strategy. The recommended transfusion thresholds are 10×10⁹/L for nonbleeding patients with hypoproliferative thrombocytopenia receiving chemotherapy or allogeneic HSCT, 20×10⁹/L for patients undergoing lumbar puncture, 10×10⁹/L for central venous catheter placement, 20×10⁹/L for low-risk interventional procedures, and 50×10⁹/L for high-risk procedures and major non-neuraxial surgery. Platelet transfusion is not recommended in the absence of bleeding in patients with hypoproliferative thrombocytopenia undergoing autologous HSCT, aplastic anemia, dengue-related consumptive thrombocytopenia, intracranial hemorrhage with platelet counts >100×10⁹/L, or during cardiovascular surgery. .

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of platelet transfusion are prepared by our editorial team based on guidelines from the International Collaboration for Transfusion Medicine Guidelines (ICTMG/AABB 2025), the British Society for Haematology (BSH 2024,2023,2022), the European Association for the Study of the Liver (EASL 2023), the European Society of Anaesthesiology and Intensive Care (ESAIC 2023), the ...
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Diagnostic investigations

Evaluation of thrombocytopenia: as per ESAIC 2023 guidelines, do not use the platelet count alone as a bleeding predictor. Take into account the cause of thrombocytopenia, platelet function, and patient- and procedure-related risk of bleeding when deciding on the need for prophylactic platelet transfusion.
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Therapeutic procedures

Indications for transfusion, critical illness: as per ESAIC 2023 guidelines, use a restrictive platelet transfusion strategy in patients with critical illness.
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More topics in this section

  • Indications for transfusion, catheter placement/removal

  • Indications for transfusion, catheter placement/removal (BCHS)

  • Indications for transfusion, invasive procedures

  • Indications for transfusion, biopsy

  • Indications for transfusion, surgery

  • Indications for transfusion, bleeding

  • Indications for transfusion, congenital platelet function disorders

  • Indications for transfusion, antiplatelet therapy

  • Indications for transfusion, consumptive thrombocytopenia

  • Indications for transfusion, immune thrombocytopenia

  • Indications for transfusion, thrombotic microangiopathies

  • Indications for transfusion, HELLP syndrome

  • Indications for transfusion, hypoproliferative thrombocytopenia

  • ABO and RhD matching

  • HLA matching

  • Human platelet antigen matching

  • Platelet leukoreduction

Specific circumstances

Preterm neonates: as per AABB/ICTMG 2025 guidelines, administer platelet transfusion in preterm neonates without major bleeding when the platelet count is < 25×10⁹/L.
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Follow-up and surveillance

Post-transfusion monitoring
As per ASCO 2018 guidelines:
Assess post-transfusion platelet counts to confirm that the desired platelet count level has been reached if platelet transfusions are administered before a procedure.
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Assess platelet counts 10-60 minutes after the transfusion if platelet transfusion refractoriness is suspected. Diagnose platelet transfusion refractoriness only when at least two transfusions of ABO-compatible units stored for < 72 hours result in poor increments, as patients may exhibit a poor increment to a single transfusion but show excellent platelet increments with subsequent transfusions.
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