title: Platelet transfusion in hematology, oncology and surgery.
abstract: BACKGROUND
  The standard recommendation to date has been that acute hypoproliferative thrombocytopenia should be treated with a prophylactic platelet transfusion if the morning platelet count is less than 10 000/μL, or less than 20 000/μL if there are additional risk factors. For chronic thrombocytopenia, transfusion has been recommended if the platelet count is less than 5000/μL. In Germany, half a million platelet transfusions are now being given every year, and the number is rising. New studies indicate, however, that a more restrictive transfusion strategy is justified.
  
  
  METHODS
  A selective literature search was carried out in PubMed, with additional attention to recommendations from Germany and abroad, and to the guidelines of medical specialty societies.
  
  
  RESULTS
  Prophylactic platelet transfusions should be given when clinically indicated in consideration of the individual hemorrhagic risk. To prevent severe hemorrhage, it is more important to respond to the first signs of bleeding than to pay exclusive attention to morning platelet counts below 10 000/μL. This threshold value remains standard for patients with acute leukemia. According to recent studies, however, clinically stable patients who are at low risk for bleeding-e.g., patients who have undergone autologous hematopoietic stem-cell transplantation-may be well served by a therapeutic, rather than prophylactic, platelet transfusion strategy, in which platelets are transfused only when evidence of bleeding has been observed. For cancer patients, intensive-care patients, and patients with other risk factors, a clinically oriented transfusion strategy is recommended, in addition to close attention to threshold platelet values.
  
  
  CONCLUSIONS
  The number of platelet transfusions could be safely lowered by a more restrictive transfusion strategy that takes account of the risk of bleeding, as recommended in the hemotherapy guidelines.
authors.affiliation: Medical Clinic 5-Nuremberg Hospital: Internal Medicine, Oncology, Hematology, Institute of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt-University of Greifswald.
authors.forename: Hannes
authors.initials: H
authors.lastname: Wandt
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schäfer-Eckart
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005858:Germany; D006405:Hematology / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000592:standards; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D017713:Platelet Transfusion / Q000592:standards*; D019106:Postoperative Hemorrhage / Q000628:therapy*; D017410:Practice Guidelines as Topic; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents