title: Optimizing platelet transfusions.
abstract: OBJECTIVE
  Platelet transfusion remains a challenging procedure. Concerns about bacterial contamination and other complications, and the interest in improving the evidence base for criteria for platelet transfusion thresholds and policies have provided impetus for studies that challenge the status quo. The current review highlights recent studies and reviews which address these questions in innovative and thoughtful ways.
  
  
  RESULTS
  Randomized controlled trials have determined that prophylactic platelet transfusions for the prevention of bleeding in chemotherapy and hematopoietic stem cell transplant patients are superior to a therapeutic approach. For the treatment of immune refractoriness, an observational study identified that of the two main ways to treat, the provision of human leukocyte antigen-matched or cross-matched platelets, neither appears to be as effective as previously believed. When emergent reversal of antiplatelet medications is desired, platelet transfusion is common, however the evidence as to the benefit of this practice is indeterminate. ABO plasma-incompatible platelet transfusion remains a challenge as this product may pose an increased risk for hemolysis. Low-anti-A, anti-B titered products are encouraged, but are not routinely available.
  
  
  CONCLUSIONS
  Platelet transfusion practices are being questioned more than ever before. As we develop better therapies and guidelines, the practice of platelet therapy can be expected to change in the near future.
authors.affiliation: aBlood Center of Wisconsin, Medical Sciences and Blood Research Institutes, Milwaukee, Wisconsin bHeartland Blood Center, Aurora, Illinois cDepartment of Pathology, McGaw Medical Center of Northwestern University, Chicago, Illinois dDepartment of Laboratory Medicine, Geisinger Health System, Danville, Pennsylvania, USA.
authors.forename: Kyle
authors.initials: K
authors.lastname: Annen
authors.forename: Jordan E
authors.initials: JE
authors.lastname: Olson
mesh_terms: D006801:Humans; D017713:Platelet Transfusion / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic