Perioperative Platelet Transfusions

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


Anesthesiology. 2021;134(3):471-479. 

In This Article

Rationale for Perioperative Platelet Transfusion

Platelets are transfused perioperatively either as prophylaxis against bleeding or as therapy to stop it. The value of platelet transfusion at extremes of thrombocytopenia, injury, and blood loss is not in question,[10] but an anesthesiologist is more likely to encounter situations where the marginal utility of platelets is uncertain. Attempts to establish practical transfusion triggers in common scenarios usually fail to produce consensus.[11–13] Appropriate triggers according to functional tests such as platelet function analyzers and viscoelastic testing are also unclear, and may not be superior to algorithms based on platelet count alone.[11,14] It is not surprising that anesthesiologists report using patient history, the surgical scenario, and the amount of blood loss to guide platelet therapy with only partial reference to laboratory values. Not surprisingly, there is a wide variation in perioperative platelet transfusion practice.[15,16]