Key Takeaways

✅ Indication for prophylactic platelet transfusions are:

• Prophylactic for thrombocytopenia with platelet counts:
  • <10 x 10⁹/L (to prevent spontaneous bleeding).
  • <20 x 10⁹/L if fever, sepsis, mucositis are present or in anticipation of a minor procedure (central venous catheter insertion or removal, biopsy).
  • <50 x 10⁹/L in anticipation of major procedure/surgery.
  • <100 x 10⁹/L for neurosurgery or ophthalmologic procedures.
• Therapeutic:
  • In bleeding patients with platelet count is <50 x 10⁹/L,
  • In patients with neuroaxial bleeding and platelet count <100 x 10⁹/L
  • In bleeding patients with congenital or acquired thrombocytopathies regardless of the platelet count.

✅ Platelets are contraindicated in thrombotic thrombocytopenia purpura (TTP), heparin-induced thrombocytopenia (HIT), immune thrombocytopenia (ITP), and uremia-related platelet dysfunction unless life-threatening bleeding is present.

✅ Two CCI < 7500 with platelet counts taken within one-hour post-transfusion is consistent with immune refractoriness and warrants further testing to detect the presence of anti-HLA and anti-HPA antibodies. ABO-matched/compatible platelets should also be given to these patients.