While RBC transfusions have declined with the widespread adoption of restrictive thresholds, platelet transfusions have remained steady in recent years. Updated clinical practice guidelines, however, from the Association for the Advancement of Blood and Biotherapies (AABB) and International Collaboration for Transfusion Medicine Guidelines (ICTMG) now recommend restrictive platelet transfusion strategies across a broader range of clinical scenarios. Although some of the updated recommendations are similar to those previously published by AABB —such as those for patients with hypoproliferative thrombocytopenia, cardiovascular surgery, and nonneuraxial surgery—the updated guidelines extend to new populations, including neonates, patients undergoing stem cell transplants and patients with dengue. Strong recommendations supported by high-quality evidence include restrictive platelet thresholds for non-bleeding patients with hypoproliferative thrombocytopenia, preterm neonates, and patients undergoing lumbar puncture. Additionally, platelet transfusions are not recommended for patients with dengue-related consumptive thrombocytopenia who are not actively bleeding. Several conditional recommendations were also made for other patient populations, reflecting a lower certainty of evidence. While restrictive platelet transfusion strategies help reduce the risk of adverse events and mitigate platelet shortages, further randomized clinical trials are needed to strengthen the evidence base and improve guidelines for specific populations.
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