What are the guidelines for plasma and platelet transfusion for the treatment of DIC in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

In 2009, the British Committee for Standards in Haematology (BCSH) published their guidelines recommendations, in which they state that treating the underlying etiology is “the cornerstone” of DIC therapy. [111] The BSCH guidelines regarding adjunctive treatment (eg, plasma and platelet transfusion, anticoagulation, use of anticoagulant factor concentrates, and antifibrinolytic therapy) are discussed below.

Plasma and platelet transfusion

In general, the BSCH recommends reserving transfusion of platelets or plasma (components) for patients with DIC who are bleeding (rather than administering this therapy on the basis of laboratory findings). Thus, platelet transfusion should be considered in patients with DIC and bleeding (or a high risk of bleeding) who have a platelet count below 50 × 109/L (50,000/µL). [111] The Surviving Sepsis Campaign suggests considering platelet transfusion in such patients when platelet counts are below 20 × 109/L (20,000/µL). [11]

Other BSCH plasma/platelet transfusion guidelines include the following [111] :

  • Do not administer prophylactic platelet transfusions in nonbleeding patients unless they are at high risk of bleeding

  • Consider administering FFP in patients with DIC and active bleeding who have prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), as well as those who may undergo an invasive procedure; do not administer FFP solely on the basis of laboratory findings

  • Consider administering factor concentrates (eg, prothrombin complex concentrate) if FFP cannot be transfused; note that these agents contain only selected factors and will not completely correct the DIC

  • Consider administering fibrinogen concentrate or cryoprecipitate in cases of persistent severe hypofibrinogenemia (< 1 g/L) despite FFP therapy


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