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.

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