Platelet Transfusion

Platelets play an essential role in the maintenance of normal hemostasis. Platelet transfusions are commonly administered to patients of all ages with thrombocytopenia or platelet dysfunction. Prophylactic platelet transfusions aim to reduce bleeding risk, while therapeutic transfusions are utilized to control active bleeding. For many clinical settings, optimal thresholds for platelet transfusions have not been established through high-quality randomized controlled trials (RCTs). New diagnosis of thrombocytopenia should prompt evaluation to determine and, if possible, address the cause. Platelets should be transfused on the basis of platelet count or platelet function, active bleeding or impending invasive procedures, and other risk factors for bleeding (e.g., coagulopathy). A few evidence-based, clinical practice guidelines have been published to guide adult platelet transfusion. Due to a scarcity of evidence and despite the unique features of neonatal and pediatric populations, including their distinct physiology, the conclusions of RCTs conducted in adults are sometimes also applied to these populations. This chapter describes the existing evidence and platelet transfusion guidelines for adults and children.