New guidelines from the AABB (formerly, the American Association of Blood Banks) specify clinical situations in which platelet transfusion is recommended in adult patients. The guidelines are being published in Annals of Internal Medicine. Platelet transfusions are administered to prevent or treat bleeding in patients with quantitative or qualitative platelet disorders. To inform its recommendations, researchers for the AABB conducted a systematic review of randomized, clinical trials and observational studies that reported clinical outcomes in patients receiving prophylactic or therapeutic platelet transfusions.
They developed guidelines that address several common clinical situations and attempt to identify a platelet count threshold below which platelet transfusion may improve hemostatis and above which platelet transfusion is unlikely to benefit the patient. Based on strong evidence, the AABB recommends prophylactic platelet transfusion to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia and a platelet count of 10# x #109 cells/L.
Weaker evidence suggests that prophylactic platelet transfusion should be administered in patients having elective central venous catheter placement with a platelet count of less than 20# x #109 cells/L or patients having elective diagnostic lumbar puncture or major elective nonneuraxial surgery with a platelet count less than 50# x #109 cells/L. The AABB recommends against routine prophylactic platelet transfusion in patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass but suggests (without recommending) that those with perioperative bleeding and thrombocytopenia or platelet dysfunction may benefit from transfusion.
Source: American College of Physicians