Today we’ll be discussing a new set of guidelines for platelet transfusions from the AABB. In the United States, over 2 million platelet doses are transfused each year. Many hematology, oncology and surgery patients receive prophylactic platelet transfusions to reduce the risk of spontaneous bleeding.
Dr. Richard Kaufman, who was one of the 21 experts the AABB commissioned to write the guidelines, comments:
“There are number of known risks to platelet transfusion. They’re a very difficult product for blood banks to manage simply because of the short shelf life, and they are very expensive. And for all of these reasons, we feel that it is important both to try to optimize their clinical uses as well as preserve the resource.”
The first section of the new AABB guidelines addresses hematology-oncology patients undergoing chemotherapy or stem cell transplants. To reduce the risk of spontaneous bleeding, the AABB recommends prophylactic platelet transfusion for these patients when their platelet count falls below 10,000 per microliter.
The second section of the guidelines outlines other clinical recommendations. The AABB does not recommend platelet transfusions for cardiac surgery patients with normal platelet function and counts. The guidelines do, however, recommend transfusing patients have either a lumbar puncture or major surgery when platelet counts are below 50,000 per microliter.
Breaking from other published guidelines, prophylactic platelet transfusions are recommended by the AABB when platelet counts fall below 20,000 per microliter for patients receiving central venous catheter placement.
For the clinical implications of these guidelines, Dr. Kaufman adds:
“It’s hoped that clinicians will be less ready to transfuse patients who are sort of moderately thrombocytopenic, but truthfully are really unlikely to experience excessive bleeding.”
The guidelines committee noted numerous areas where additional research is needed. However, the new guidelines should help clinicians balance platelet transfusion risks against patient outcomes and conserve platelet resources.
We’ll be back with another edition of Transfusion News on November 30th. Thanks for joining us.
1. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O’Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, and Tobian AAR for the Clinical Transfusion Medicine Committee of the AABB. Platelet transfusion: a clinical practice guideline from the AABB. Annals of Internal Medicine 2014.
2. Kumar A, Mhaskar R, Grossman BJ, Kaufman RM, Tobian AAR, Kleinman S, Gernsheimer T, Tinmouth A, and Djulbegovic B on behalf of AABB Platelet Transfusion Guidelines Panel. Platelet transfusions: a systematic review of the clinical evidence. Transfusion 2014.