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May 2024 QQ Summary: Platelet Transfusion Trigger

Our May 2024 Quick Question was a survey that asked, “Below what PLT count limit do you provide PLT concentrate?” our 25 participants answered as follows:

  1. <150,000/uL: 2 [8%]
  2. <50,000/uL: 3 [12%]
  3. <20,000/uL: 7 [28%]
  4. <10,000/uL: 13 [52%]
  5. <5,000/uL: 0

The correct answer is “it depends.” Current WHO platelet concentrate transfusion guidelines are available at Czempik PF, Herzyk J, Wilczek D. Let us know transfusion triggers for prophylactic use of platelet concentrate-analysis of compliance with recent transfusion guidelines in a large academic medical center. J Clin Med. 2023;12:5885. doi: 10.3390/jcm12185885. PMID: 37762827; PMCID: PMC10532288. Platelet concentrate transfusion is used in moderate, severe, or severe bleeding in traumatic brain injury with platelet count triggers of <30,000/uL, <50,000/uL, or < 100,000/uL respectively. Platelets may be used prophylactically in bone marrow dysfunction, hematological disorders, or certain invasive procedures, however, the authors comment that “Inappropriate transfusions accounted for 53.3% of cases, and most of them were given prophylactically (80.2%).”

Outpatient platelet transfusion triggers and frequency are documented in O’Brien K, Bakhtary S, Benson K, Stephens L, Lu W. A national survey of outpatient platelet transfusion practice. Am J Clin Pathol. 2022;158:687–91. doi: 10.1093/ajcp/aqac102. PMID: 36017577. The abstract states:

Objectives: Platelets are a limited resource frequently subject to inventory shortages. It benefits all to transfuse judiciously, according to evidence-based guidelines. Several organizations have published recommendations for platelet transfusions, but none specifically focused on outpatients. The Clinical Hemotherapy subsection of the Association for the Advancement of Blood & Biotherapies (AABB) Transfusion Medicine Subsection Coordinating Committee conducted a survey targeting outpatient transfusions to understand current practice in the United States.

Methods: To determine use of platelets in the outpatient setting, a survey was developed, piloted, validated, and distributed by email to 735 AABB members. Frequencies were calculated and free-text comments categorized.

Results: A total of 317 responses were received (43% response rate) from 44 states. Half the respondents’ institutions have formal outpatient platelet guidelines. Slightly more than half the respondents (51%) with guidelines used a threshold of less than 10,000/µL when transfusing stable, afebrile outpatients, with 29% using less than 20,000/µL. Fewer than half (45%) monitored outpatient platelet use by prospective and retrospective audits, with the next-largest group (25%) using retrospective audits only.

Conclusions: Approximately half the respondents had outpatient guidelines, and half used a threshold of less than 10,000/µL when transfusing platelets to stable outpatients. Greater adoption of this threshold and monitoring may improve the nation’s platelet inventory.

Keywords: Guidelines; Outpatient; Platelets; Transfusion.

Fritsma Factor welcomes your comments on platelet concentrate transfusion guidelines.

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