| Thrombocytopenia due to impaired platelet production | Platelet count thresholds for platelet transfusion |
| Prophylactic transfusion: <10,000/μL* | |
| Coverage for invasive procedures | |
| Minor invasive procedures (eg, LP, CVC placement, epidural anesthesia, endoscopy with biopsy, or liver biopsy): 50,000/μL† | |
| Major surgery in noncritical sites: 50,000–100,000/μL‡ | |
| Major surgery in critical sites (eg, eyes, brain): 100,000/μL | |
| Active bleeding: 50,000–100,000/μL | |
| Autoimmune thrombocytopenia | Platelet transfusion should only be undertaken in instances of serious or life-threatening bleeding (eg, gastrointestinal or intracranial hemorrhage) |
| Large amounts of platelets may be required to boost the platelet count, given the shortened survival of the transfused platelets; concomitant administration of immune-modulating therapies (eg, steroids or IVIG) may attenuate this process, resulting in a more rapid rise in platelet count | |
| Platelet function disorders | For active bleeding or hemostatic surgical coverage |
| Eliminate or mitigate any factors contributing to platelet dysfunction (eg, medications, underlying conditions) | |
| Desmopressin may be considered in patients with inherited platelet function disorders, particularly storage pool defects, or in patients with uremia | |
| Platelet transfusion may be considered when the above measures are not indicated or are unsuccessful |
↵* In some cases, the platelet count threshold for prophylactic transfusion may be higher (eg, in patients with sepsis, acute bleeding, other coagulation abnormalities, or necrotic tumors receiving aggressive treatment) or lower (eg, in patients at risk for platelet alloimmunization or refractoriness because of frequent transfusions).69,70
↵† The threshold for platelet transfusion before bone marrow aspiration and biopsy is unknown.69 It has been suggested that, even in the presence of severe thrombocytopenia, this procedure may be performed without prior platelet transfusion, provided that adequate surface pressure is applied.70
↵‡ Platelet count threshold will vary depending on the type and extent of surgery and presence of factors that may affect platelet function (eg, uremia, medications, extracorporeal circulatory support for surgery, comorbid conditions).69,70
CVC, central venous catheter; IVIG, intravenous immunoglobulin; LP, lumbar puncture.