ASCO GUIDELINES Bundle

Treatment Platelet Transfusion Threshold in the Setting of Hematopoietic Stem Cell Transplantation ➤ UPDATED. The Panel recommends a threshold of <10 x 10 9 /L for prophylactic platelet transfusion in adult and pediatric patients undergoing allogeneic HSCT. Prophylactic platelet transfusion may be administered at higher counts based on clinician judgment. In adult recipients of autologous HSCT, randomized trials have demonstrated similar rates of bleeding with decreased platelet usage when patients are transfused at the first sign of bleeding rather than prophylactically, and this approach may be used in experienced centers. This recommendation is not generalizable to pediatric patients. (Moderate Recommendation; EB-H) Platelet Transfusion in Patients with Chronic, Stable, Severe Thrombocytopenia Who Are Not Receiving Active Treatment ➤ Patients with chronic, stable, severe thrombocytopenia, such as individuals with myelodysplasia or aplastic anemia, who are not receiving active treatment may be observed without prophylactic transfusion, reserving platelet transfusions for episodes of hemorrhage or during times of active treatment. (Moderate Recommendation; IC-I) Platelet Transfusion Threshold in Patients With Solid Tumors ➤ UPDATED. The risk of bleeding in patients with solid tumors during chemotherapy-induced thrombocytopenia is related to the depth and duration of the platelet nadir, although other factors contribute as well. The Panel recommends a threshold of <10 X 10 9 /L for prophylactic platelet transfusion, based on extrapolation from studies in hematologic malignancies. Platelet transfusion at higher levels is appropriate in patients with active localized bleeding, which can sometimes be seen in patients with necrotic tumors. (Moderate Recommendation; IC-L) Platelet Count at which Surgical or Invasive Procedures May Be Performed ➤ The Panel recommends a threshold of 40 x 10 9 /L to 50 x 10 9 /L for performing major invasive procedures in the absence of associated coagulation abnormalities. Certain procedures, such as bone marrow aspirations and biopsies, and insertion or removal of central venous catheters can be performed safely at counts ≥20 x 10 9 /L. There are sparse data, and no randomized trials, addressing the safety of other invasive procedures at much lower count levels. If platelet transfusions are administered before a procedure, it is critical that a posttransfusion platelet count be obtained to prove that the desired platelet count level has been reached. Platelet transfusions should also be available on short notice, in case intraoperative or postoperative bleeding occurs. For alloimmunized patients, histocompatible platelets must be available in these circumstances. (Weak Recommendation; EB-L)

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