Disclaimer: Information in this application is based on national guidelines - your hospital may have local variations.

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Risk factors
for bleeding
Classification of conditions which may require platelet transfusion

Risk factors
for bleeding
Alternatives to platelets transfusion

General measures
Stop all anti-platelet agents whenever possible
Apply surface pressure after superficial procedures
Treat any surgical cause for bleeding
Consider tranexamic acid to treat bleeding
Specific patient populations
Liver disease - give vitamin K
Uraemia - dialyse, correct Hct to 0.3%, consider Desmopressin (DDAVP) with specialist renal advice
Inherited platelet function disorders. Consider Desmopressin (DDAVP). Specialist haematology advice required.
Splenomegaly/hypersplenism - consider splenectomy or splenic irradiation with specialist haematology advice

Risk factors
for bleeding
Indications for use of platelet transfusions

Prior to prescribing a platelet transfusion consider:

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Risk factors
for bleeding
Indications for use of platelet transfusions (continued)

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Risk factors
for bleeding
Indications for use of platelet transfusions (continued)

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Remember:

- Reversible bone marrow failure Platelet count threshold for transfusion10 x 109/L
- Chronic bone marrow failure, peripheral destruction/consumption, abnormal platelet function Not indicated
- Reversible/chronic bone marrow failure Platelet count threshold for transfusion20 x 109/L
- Peripheral destruction/consumption, abnormal platelet function Not indicated
Reversible/chronic bone marrow failure and platelet destruction/consumption if urgent/other therapy failed Platelet count threshold for transfusion 
- Bone marrow aspirate or trephine Not indicated
- Epidural anaesthesia 80 x 109/L
- *All other procedures 50 x 109/L
Abnormal platelet function  
- Bone marrow aspirate or trephine Not indicated
- All other procedures in selected patients if alternative therapy failed/contraindicated Not possible to state threshold

* American Society for Haematology ITP guidelines recommend a threshold count of 80 for major surgery

- Reversible/chronic bone marrow failure and platelet destruction/consumption if urgent/other therapy failed Platelet count threshold for transfusion100 x 109/L
- Abnormal platelet function in selected patients if alternative therapy failed/contraindicated Not possible to state threshold
*All patient indication categories. If patient has major bleeding keep platelet count above 50x109/L, aim for 75x109/L Platelet count threshold for transfusion75 x 109/L
For patients with multiple trauma or CNS injury 100 x 109/L

* Thrombotic Thrombocytopenic Purpura (TTP) and Heparin-Induced Thrombocytopenia (HIT) platelet transfusion contraindicated unless life-threatening haemorrhage

  • If patient has clinically significant but not major bleeding give a standard platelet dose and reassess
  • Significant bleeding is defined as a more significant haemorrhage than: sparse petechiae; a nosebleed/bleeding from the mouth lasting less than 30 mins; one or two bruises up to 10cm in size; microscopic haematuria; vaginal bleeding that is only spotting of blood
  • Major bleeding is defined as bleeding requiring extra interventions to stop the bleeding, bleeding requiring blood product support, bleeding causing haemodynamic compromise

Please make sure that:
-The indication has been documented in the patient's record and on the transfusion request form.

-That the patient has consented to receive a platelet transfusion

Back to "Indications for use of platelet transfusion"

Risk factors
for bleeding
Indications for use of platelet transfusions (continued)

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Please enter the child's weight below (in kg):

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Risk factors
for bleeding
Indications for use of platelet transfusions (continued)

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Risk factors
for bleeding
Indications for use of platelet transfusions (continued)

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Calculation:

Remember: When using the platelet count to assess the effectiveness of the platelet transfusion a full blood count taken 10 minutes after the transfusion is equivalent to a 1 hr platelet count increment.

- Stable preterm or term infant Platelet count threshold for transfusion20 x 109/L
- Sick preterm or term infant 30 x 109/L
- Small preterm infant Higher threshold, not specified
- Neonatal alloimmune thrombocytopenia 30 x 109/L
- Reversible bone marrow failure 10 x 109/L
- Chronic bone marrow failure, peripheral destruction/consumption, abnormal platelet function Not indicated
- Additional risk factors include severe mucositis, local tumour infiltration, platelet count likely to fall to <10 x 109/L before next evaluation, anticoagulation therapy. Platelet count threshold for transfusion20 x 109/L
- Severe hyperleucocytosis or disseminated intravascular coagulation (DIC) with induction therapy for leukaemia 40 x 109/L
- DIC 20 x 109/L
- Reversible chronic bone marrow failure 20 x 109/L
- Peripheral destruction/consumption, abnormal platelet function Not indicated
- ECMO Platelet count threshold for transfusion100 x 109/L
- Lumbar puncture or indwelling line insertion in children 40 x 109/L
Reversible/chronic bone marrow failure and platelet destruction/consumption if urgent/other therapy failed  
- Bone marrow aspirate or trephine Not indicated
- Epidural anaesthesia 80 x 109/L
- *All other procedures 50 x 109/L
Abnormal platelet function  
- Bone marrow aspirate or trephine Not indicated
- All other procedures in selected patients if alternative therapy failed/contraindicated Not possible to state threshold

* American Society for Haematology ITP guidelines recommend a threshold count of 80 for major surgery

- Reversible/chronic bone marrow failure and platelet destruction/consumption if urgent/other therapy failed Platelet count threshold for transfusion100 x 109/L
- Abnormal platelet function in selected patients if alternative therapy failed/contraindicated Not possible to state threshold
*All patient indication categories. If patient has major bleeding keep platelet count above 50x109/L, aim for 75x109/L Platelet count threshold for transfusion75 x 109/L
For patients with multiple trauma or CNS injury 100 x 109/L

* Thrombotic Thrombocytopenic Purpura (TTP) and Heparin-Induced Thrombocytopenia (HIT) platelet transfusion contraindicated unless life-threatening haemorrhage

  • If patient has clinically significant but not major bleeding give a standard platelet dose and reassess
  • Significant bleeding is defined as a more significant haemorrhage than: sparse petechiae; a nosebleed/bleeding from the mouth lasting less than 30 mins; one or two bruises up to 10cm in size; microscopic haematuria; vaginal bleeding that is only spotting of blood
  • Major bleeding is defined as bleeding requiring extra interventions to stop the bleeding, bleeding requiring blood product support, bleeding causing haemodynamic compromise

Please make sure that:
-The indication has been documented in the patient's record and on the transfusion request form.

-That the patient has consented to receive a platelet transfusion

Back to "Indications for use of platelet transfusion"

Risk factors
for bleeding
Platelet transfusion: principles, contraindications and risks

Platelet transfusion: principles, contraindications and risks

Platelets are used in 3 distinct situations:

Risk factors
for bleeding
Contraindications to platelet transfusion unless life-threating haemorrhage

Risk factors
for bleeding
Risks associated with platelet transfusion

Reduced effectiveness of future platelet transfusion

Alloimmunisation
Even if patients do not develop alloimmunisation the interval between platelet transfusions and corrected count increment decrease as the number of previous transfusions received increase.
For further information on platelet refractoriness check here

Adverse effects

Febrile non-haemolytic transfusion reactions. Incidence approximately 2%. May require investigation to exclude other causes e.g. bacterial infection (see below) and prolong hospital stay.

Transfusion-transmitted bacterial infection. 1 in 600 platelet units contain bacteria when cultured but reactions only occur in approximately 1 in 10,000 platelet transfusions. 25% (11/43) of all patients who acquired transfusion-transmitted bacterial infection reported to Serious Hazards of Transfusion (SHOT) died.

Allergic reactions. Incidence of cutaneous reactions approximately 4%. Anaphylaxis rare (1 in 20,000 to 1 in 50,000 of all transfusions) but 40% (14/34) of all 2010 SHOT reports associated with platelets.

Transfusion related acute lung injury. This is a serious but unusual complication of transfusion but platelets are around 8 times more likely to be implicated than red cells. Mortality rate 9%.

Risk factors
for bleeding
Administration of platelets

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Risk Factors for bleeding

InfectionSystemic infection e.g. pneumonia, septicaemia Platelet count threshold for transfusion20x109/L
Treatment with therapeutic antifungals e.g.Ambisome/ Amphocil/ Amphotericin B Higher threshold - seek advice
Bleeding diathesisTreatment with anticoagulants Higher threshold - seek advice
Treatment with antiplatelet agents Higher threshold - seek advice
Treatment with Anti-thymocyte Globulin 30x109/L
Treatment with Bortezomib 30x109/L
Inherited bleeding problem
e.g. haemophilia, von Willebrand's disease, platelet function disorder
Higher threshold - seek advice
Acquired bleeding disorder
(not associated with medication or promyelocytic leukaemia) e.g. Disseminated Intravascular Coagulation
20x109/L
(>50x109/L if bleeding)
Coagulopathy associated with promyelocytic leukaemia 20x109/L
(>50x109/L if bleeding)
Increased bleeding riskRecent major operation (i.e. within the previous 2 weeks) 50x109/L
Recent significant haemorrhage Higher threshold - seek advice
Local tumour infiltration 20x109/L
Pregnant 20x109/L
Severe mucositis 20x109/L
Severe leucocytosis
(WCC > 100)
40x109/L
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