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)
