New Guidelines Include Significant Changes to Platelet Transfusion Practice

In certain clinical situations, patients with low numbers of platelets (the cells that trigger blood clots) or with impaired platelet function may be considered for platelet transfusion with the intention of preventing or treating bleeding. But platelets are also the riskiest blood product to transfuse, sometimes leading to important side effects, such as allergic reactions and circulatory overload.

New guidelines produced by an international team of researchers led by Ryan Metcalf, MD, associate professor of pathology at University of Utah Health, suggest that doctors should be doing considerably fewer platelet transfusions than previous guidelines indicated. The guidelines include new or updated recommendations for a wide variety of patient populations, including preterm infants and patients with diseases—like dengue fever—that affect platelet count and function.

The new guidelines are published in JAMA and featured as the editor’s choice article.

Using platelet transfusions more liberally, as defined in randomized trials, didn’t show clear evidence of benefit for outcomes of death or bleeding, the authors found via a synthesis of the research literature. And because platelets are often in short supply, avoiding unnecessary transfusions will help ensure that there are enough platelets for patients who need them.

“Platelets have the highest risk of adverse events of any blood product, are the costliest, and have the shortest shelf life,” Metcalf explains. “Therefore, the benefits of restrictive transfusion strategies for platelets would be avoiding harm from unnecessary transfusion, maintaining adequate supply, and, lastly, reducing costs.”

Nationwide, doctors perform over two million platelet transfusions every year; if implemented, the new guidelines would be expected to decrease this significantly, reducing the incidence of side effects and conserving platelets for patients who are most likely to benefit.

Listen to a podcast on the guidelines here.