Platelet Transfusion Triggers

February 13, 2018

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Transfusion of platelets prophylactically may do more harm than good.

Why does this matter?
We like to fix things. Low K? Replace it.  Low platelets? Transfuse.  But does it help critically ill patients to transfuse patients with no bleeding just because they are low?

An ounce of prevention

This was a retrospective study and propensity-matched analysis of 994 patients who were given prophylactic platelet transfusion and 994 matched patients who were not.  They found that those who received platelets got more red cell transfusions, were in the ICU and hospital longer, and had less improvement in SOFA score in the subsequent 24 hours.  Keep in mind, this is a retrospective study and, even with propensity-matched analysis, is subject to confounding.  But all told, prophylactic transfusion didn’t seem to be of benefit – even for platelet counts as low as 20×10^9/L.  For the ED, the take home is to transfuse platelets in thrombocytopenic patients with bleeding, not prophylactically.

Source
Prophylactic Platelet Transfusions for Critically Ill Patients With Thrombocytopenia: A Single-Institution Propensity-Matched Cohort Study. Anesth Analg. 2017 Dec 29. doi: 10.1213/ANE.0000000000002794. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.