Examples of various recommendations in transfusion guidelines relevant to prophylactic platelet transfusions
| Society/recommendations . | Strength of recommendation . | Quality of evidence . |
|---|---|---|
| European Society of Intensive Care Medicine 202061 | ||
| We suggest not using platelet transfusion to treat thrombocytopenia unless the platelet count falls below 10 × 109/L. | Conditional | Very low |
| We make no recommendation regarding prophylactic platelet transfusion before invasive procedures for platelet counts between 10 × 109/L and 50 × 109/L. | Research recommendation | |
| We suggest not giving prophylactic platelet transfusion before percutaneous tracheostomy or central venous catheter insertion for platelet counts between 50 100 × 109/L and 100 × 109/L. | Conditional | Very low |
| Society of Interventional Radiology 2019124 | ||
| Consider platelet transfusion if platelet count is <20 × 109/L for procedures with low bleeding risk (eg, central venous access, including PICC placement, dialysis access, lumbar puncture, paracentesis, thoracentesis, transjugular liver biopsy, or superficial abscess drainage). | Weak | Limited (evidence level D) |
| Consider platelet transfusion if platelet count is <50 × 109/L for procedures with high bleeding risk (eg, deep abscess drainage, solid organ biopsies, arterial intervention <7 French sheath, gastrostomy, urinary tract interventions [nephrostomy, stone removal], or transjugular intrahepatic portosystemic shunt). | Weak | Limited (evidence level D) |
| British Society for Haematology 201787 | ||
| Consider performing the following procedures above the platelet count threshold indicated: | ||
| Central venous lines, >20 × 109/L (using ultrasound) | Strong | Moderate |
| Major surgery, >50 × 109/L | Strong | Low |
| Lumbar puncture, ≥ 40 × 109/L | Weak | Low |
| Insertion/removal of epidural catheter, ≥80 × 109/L | Weak | Low |
| Neurosurgery or posterior segment ophthalmic surgery, >100 × 109/L | Strong | Low |
| Percutaneous liver biopsy, >50 × 109/L (consider transjugular biopsy if platelet count is lower) | Weak | Moderate |
| Give prophylactic platelet transfusions (platelet transfusions to patients who do not have clinically significant bleeding and do not require a procedure) to patients with reversible bone marrow failure (eg, general critical illness, receiving intensive chemotherapy, or undergoing hematopoietic stem cell transplantation) at or above 10 × 109/L. | Strong | Moderate |
| Consider increasing the threshold for prophylactic platelet transfusion to between 10 × 109/L and 20 × 109/L in patients judged to have additional risk factors for bleeding (eg, sepsis). | Weak | Low |
| American Association of Blood Banks (AABB) 20155 | ||
| Suggest prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count <20 × 109/L. | Weak | Low |
| Suggest prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count <50 × 109/L. | Weak | Very low |
| Suggest prophylactic platelet transfusion for patients having elective neuraxial anesthesia with a platelet count <50 × 109/L. | Weak | Very low |
| Recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. | Weak | Very low |
| Recommends transfusing hospitalized patients with a platelet count <10 × 109/L to reduce the risk of spontaneous bleeding. | Strong | Moderate |
| Society/recommendations . | Strength of recommendation . | Quality of evidence . |
|---|---|---|
| European Society of Intensive Care Medicine 202061 | ||
| We suggest not using platelet transfusion to treat thrombocytopenia unless the platelet count falls below 10 × 109/L. | Conditional | Very low |
| We make no recommendation regarding prophylactic platelet transfusion before invasive procedures for platelet counts between 10 × 109/L and 50 × 109/L. | Research recommendation | |
| We suggest not giving prophylactic platelet transfusion before percutaneous tracheostomy or central venous catheter insertion for platelet counts between 50 100 × 109/L and 100 × 109/L. | Conditional | Very low |
| Society of Interventional Radiology 2019124 | ||
| Consider platelet transfusion if platelet count is <20 × 109/L for procedures with low bleeding risk (eg, central venous access, including PICC placement, dialysis access, lumbar puncture, paracentesis, thoracentesis, transjugular liver biopsy, or superficial abscess drainage). | Weak | Limited (evidence level D) |
| Consider platelet transfusion if platelet count is <50 × 109/L for procedures with high bleeding risk (eg, deep abscess drainage, solid organ biopsies, arterial intervention <7 French sheath, gastrostomy, urinary tract interventions [nephrostomy, stone removal], or transjugular intrahepatic portosystemic shunt). | Weak | Limited (evidence level D) |
| British Society for Haematology 201787 | ||
| Consider performing the following procedures above the platelet count threshold indicated: | ||
| Central venous lines, >20 × 109/L (using ultrasound) | Strong | Moderate |
| Major surgery, >50 × 109/L | Strong | Low |
| Lumbar puncture, ≥ 40 × 109/L | Weak | Low |
| Insertion/removal of epidural catheter, ≥80 × 109/L | Weak | Low |
| Neurosurgery or posterior segment ophthalmic surgery, >100 × 109/L | Strong | Low |
| Percutaneous liver biopsy, >50 × 109/L (consider transjugular biopsy if platelet count is lower) | Weak | Moderate |
| Give prophylactic platelet transfusions (platelet transfusions to patients who do not have clinically significant bleeding and do not require a procedure) to patients with reversible bone marrow failure (eg, general critical illness, receiving intensive chemotherapy, or undergoing hematopoietic stem cell transplantation) at or above 10 × 109/L. | Strong | Moderate |
| Consider increasing the threshold for prophylactic platelet transfusion to between 10 × 109/L and 20 × 109/L in patients judged to have additional risk factors for bleeding (eg, sepsis). | Weak | Low |
| American Association of Blood Banks (AABB) 20155 | ||
| Suggest prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count <20 × 109/L. | Weak | Low |
| Suggest prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count <50 × 109/L. | Weak | Very low |
| Suggest prophylactic platelet transfusion for patients having elective neuraxial anesthesia with a platelet count <50 × 109/L. | Weak | Very low |
| Recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. | Weak | Very low |
| Recommends transfusing hospitalized patients with a platelet count <10 × 109/L to reduce the risk of spontaneous bleeding. | Strong | Moderate |