Platelet Transfusion

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Key Points ➤ Prophylactic platelet transfusion should be administered to patients with thrombocytopenia resulting from impaired bone marrow function to reduce the risk of hemorrhage when the platelet count falls below a predefined threshold level. ➤ Recommended thresholds for prophylactic platelet transfusion are provided for patients with hematologic malignacies or solid tumors, and those undergoing hematopoietic stem cell transplantation or invasive procedures. ➤ Guidance is also provided regarding the production of platelet products, prevention of Rh alloimmunization, and management of refractoriness to platelet transfusion. Treatment Preparation of Platelet Products ➤ Platelets for transfusion can be prepared either by separation of units of platelet concentrates (PCs) from whole blood using either the buffy coat or platelet-rich plasma method, which can be pooled before administration, or by apheresis from single donors. Comparative studies have shown that the posttransfusion increments, hemostatic benefit, and side effects are similar with any of these platelet products. Thus, in routine circumstances, they can be used interchangeably. In most centers, pooled PCs are less costly. Single-donor platelets from selected donors are necessary when histocompatible platelet transfusions are needed. (Strong Recommendation; EB-H) Prevention of Rh Alloimmunization ➤ UPDATED. Prevention of RhD alloimmunization resulting from platelet transfusions to RhD-negative recipients can be done either through the exclusive use of platelet products collected from RhD-negative donors or via anti-D immunoprophylaxis. These approaches may be used for female children and female adults of childbearing potential being treated with curative intent. However, because of the low rate of RhD alloimmunization in cancer patients, these approaches need not be applied universally. (Moderate Recommendation; EB-I)

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