Perioperative Platelet Transfusions

Aaron Stansbury Hess, M.D., Ph.D.; Jagan Ramamoorthy, M.D.; John Rider Hess, M.D., M.P.H.

Disclosures

Anesthesiology. 2021;134(3):471-479. 

In This Article

Thrombocytopenia and Prophylactic Platelet Transfusions Before Low-risk Surgery

It is traditional that major surgery can proceed at or above a platelet count of 50 × 103 cells/μl.[39] Perioperative thrombocytopenia is associated with worse outcomes, but platelet transfusion in retrospective studies is not associated with reduced perioperative bleeding, transfusion, or mortality.[29,31] The American Society of Anesthesiologists states that low bleeding-risk surgeries and vaginal deliveries may be performed at a platelet count less than 50 × 103 cells/μl, and that platelet therapy may be indicated for patients with platelet counts between 50 and 100 × 103 cells/μl.[46] The American Society of Clinical Oncology recommends a slightly more relaxed threshold of 40 to 50 × 103 cells/μl for all major invasive procedures.[39]

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