When is platelet transfusion indicated?

Updated: Apr 16, 2019
  • Author: Linda L Maerz, MD, FACS, FCCM; Chief Editor: Emmanuel C Besa, MD  more...
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Platelet transfusion may be beneficial in patients with platelet deficiency or dysfunction. Prophylactic platelet transfusion is indicated in patients with bone marrow failure, no other associated risk factors for bleeding, and platelet counts below 10 X 109/L. If there are associated risk factors, the threshold may be reasonably raised to 20 X 109/L. Patients undergoing invasive procedures should have platelet counts greater than 50 X 109/L. In the hemorrhaging patient, platelet transfusion is indicated when thrombocytopenia is contributing to the bleeding and the platelet count is less than 50 X 109/L. When diffuse microvascular bleeding is present, the platelet count should be maintained above 100 X 109/L while the underlying cause of the hemorrhage is being addressed. [17, 18, 19]

Common etiologies to be corrected include, but are not limited to, large volume hemorrhage control failure (solid organ or vascular conduit), hypothermia, acidosis, traumatic brain injury, individual factor deficiencies, and acquired inhibitors of coagulation. The optimal time to measure the effect of platelet transfusion is 1 hour after the completion of the infusion. This timeframe allows one to discern an appropriate increase from ongoing consumption from total destruction due to preformed antibody.

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