Bethesda, Md. – More than two million platelet doses are transfused every year in the United States. A large proportion are used prophylactically to prevent complications associated with platelet-lowering treatments, such as chemotherapy. Additionally, platelet transfusions are often used to try to prevent or treat bleeding in patients undergoing surgical procedures, such as cardiac surgery with cardiopulmonary bypass, and other common invasive procedures. AABB, formerly the American Association of Blood Banks, developed a clinical practice guideline with recommendations for the appropriate use of such prophylactic transfusions for several common clinical settings. The guideline was published today in the “Annals of Internal Medicine.”
Unlike whole blood and other blood products, platelets must be stored at room temperature. Shelf life is limited to five days per unit to reduce the risk of bacterial growth, making it very difficult for blood banks to maintain adequate platelet inventories. Managing platelet supplies is logistically difficult, resource intensive and costly.
“The purpose of this guideline is to provide pragmatic advice on the use of platelet transfusions in a variety of clinical settings based on the best published evidence,” said Richard M. Kaufman, MD, medical director of Adult Transfusion Medicine at Brigham and Women's Hospital, Boston, and lead author of the guideline. The recommendations “provide guidance to the frontline clinicians — the people who order these products — in order to optimize patient outcomes and to preserve resources.”
AABB strongly recommends prophylactic transfusion of platelets to reduce the risk of spontaneous bleeding in adults with therapy-associated low platelet production, such as that seen with chemotherapy for cancer. Hospitalized adults should be transfused at or below 10,000 platelets/µL. In addition, AABB recommends transfusing up to a single apheresis unit or equivalent, as evidence demonstrates that greater doses are not more effective.
“AABB is dedicated to promoting appropriate patient blood management and reducing the number or unnecessary transfusions,” said Lynne Uhl, MD, AABB President and chief, Division of Laboratory and Transfusion Medicine at the Beth Israel Deaconess Medical Center in Boston. “Hospital implementation of evidence-based guidelines is critical in making sure patients receive the appropriate blood product, in the appropriate dose, only when needed.”
The guideline addresses five other common clinical situations, though the evidence is not considered to be as strong. These include prophylactic platelet transfusions for patients undergoing —
- Elective central venous catheter placement with a platelet count below 20,000/ µL;
- Elective diagnostic lumbar puncture with a platelet count below 50,000/ µL; and
- Major elective non-neuraxial surgery with a platelet count below 50,000/ µL.
The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation, or GRADE, methodology and was based on a recent systematic review of the literature on platelet transfusions. This systematic review will be published this week as an Early View article in AABB’s research journal “Transfusion.”
To view a copy of “Platelet Transfusion: A Clinical Practice Guideline from the AABB,” visit the “Annals of Internal Medicine.”
The guideline development panel included members of the AABB Clinical Transfusion Medicine Committee. The panel also included experts from the American Association of Neurological Surgeons, American Society of Anesthesiologists, The American Society of Hematology, the Society of Critical Care Medicine and the Society of Thoracic Surgeons.
AABB is an international, not-for-profit association representing individuals and institutions involved in transfusion medicine, cellular therapies and patient blood management. The association is committed to improving health by developing and delivering standards, accreditation and educational programs that focus on optimizing patient and donor care and safety. AABB membership consists of nearly 2,000 institutions and 8,000 individuals, including physicians, nurses, scientists, researchers, administrators, medical technologists and other health care providers. Members are located in more than 80 countries. For more information, visit www.aabb.org.