Platelet transfusion: a clinical practice guideline from the AABB.
BACKGROUND
The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients.


METHODS
These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.


CONCLUSIONS
The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 109 cells/L or less to reduce the risk for spontaneous bleeding. The AABB recommends transfusing up to a single apheresis unit or equivalent. Greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective. (Grade: strong recommendation; moderate-quality evidence).


CONCLUSIONS
The AABB suggests prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count less than 20 × 109 cells/L. (Grade: weak recommendation; low-quality evidence).


CONCLUSIONS
The AABB suggests prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence).


CONCLUSIONS
The AABB suggests prophylactic platelet transfusion for patients having major elective nonneuraxial surgery with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence).


CONCLUSIONS
The AABB recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. The AABB suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction. (Grade: weak recommendation; very-low-quality evidence).


CONCLUSIONS
The AABB cannot recommend for or against platelet transfusion for patients receiving antiplatelet therapy who have intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain recommendation; very-low-quality evidence).
Richard M
RM
Kaufman
Benjamin
B
Djulbegovic
Terry
T
Gernsheimer
Steven
S
Kleinman
Alan T
AT
Tinmouth
Kelley E
KE
Capocelli
Mark D
MD
Cipolle
Claudia S
CS
Cohn
Mark K
MK
Fung
Brenda J
BJ
Grossman
Paul D
PD
Mintz
Barbara A
BA
O'Malley
Deborah A
DA
Sesok-Pizzini
Aryeh
A
Shander
Gary E
GE
Stack
Kathryn E
KE
Webert
Robert
R
Weinstein
Babu G
BG
Welch
Glenn J
GJ
Whitman
Edward C
EC
Wong
Aaron A R
AA
Tobian
D000328:Adult; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000628:therapy; D017713:Platelet Transfusion; D013129:Spinal Puncture / Q000009:adverse effects; D013921:Thrombocytopenia / Q000150:complications / Q000209:etiology