NICE - indication for platelet transfusions if low platelets (thrombocytopaenia)

Platelets

Thresholds and targets

Patients with thrombocytopenia who are bleeding

Offer platelet transfusions to patients with thrombocytopenia who have clinically significant bleeding and a platelet count below 30×10^9 per litre.

A higher platelet thresholds (up to a maximum of 100×10^9 per litre) is indicated for patients with thrombocytopenia and either of the following:

• severe bleeding (WHO grades 3 and 4)
• bleeding in critical sites, such as the central nervous system (including eyes)

Patients who are not bleeding or having invasive procedures or surgery

prophylactic platelet transfusions should be offered to patients with a platelet count below 10×10^9 per litre who are not bleeding or having invasive procedures or surgery, and who do not have any of the following conditions:

• chronic bone marrow failure
• autoimmune thrombocytopenia
• heparin-induced thrombocytopenia
• thrombotic thrombocytopenic purpura.

Patients who are having invasive procedures or surgery

prophylactic platelet transfusions should be considered to raise the platelet count above 50×10^9 per litre in patients who are having invasive procedures or surgery.

a higher threshold (for example 50-75×10^9 per litre) should be considered for patients with a high risk of bleeding who are having invasive procedures or surgery, after taking into account:

• the specific procedure the patient is having the cause of the thrombocytopenia
• whether the patient's platelet count is falling
• any coexisting causes of abnormal haemostasis.

Consider prophylactic platelet transfusions to raise the platelet count above 100×10^9 per litre in patients having surgery in critical sites, such as the central nervous system (including the posterior segment of the eyes).

Reference:

• NICE (November 2015). Blood transfusion