JAMA Clinical Reviews Platelet Transfusion: Best Practice Guidelines
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May 29, 2025 Ryan Metcalf, section chief of transfusion medicine at University of Utah Health and lead author on platelet transfusion guidelines, joins Gregory Curfman to discuss essential transfusion strategies. They explore the debate between restrictive and liberal approaches, examining clinical outcomes like mortality and bleeding risks. Metcalf highlights how personalized care can impact decisions, advocating for a more therapeutic use of platelets rather than prophylactic. The conversation underscores the importance of evidence-based guidelines in enhancing patient safety and resource use.
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Restrictive Strategy in Oncology Patients
- Patients with hypoproliferative thrombocytopenia receiving chemotherapy benefit from restrictive platelet transfusions.
- Transfusing at platelet counts below 10,000 per microliter prevents bleeding without harm from liberal strategies.
Restrictive Threshold for Lumbar Puncture
- For thrombocytopenic patients undergoing lumbar puncture, the guideline recommends transfusing only if platelet count is below 20,000.
- Observational studies showed spinal hematoma rates are very low even at low platelet counts.
Avoid Platelet Transfusion in Brain Bleeds
- In adults with spontaneous or traumatic non-operative intracranial hemorrhage and normal platelet counts, no platelet transfusion is recommended.
- The evidence suggested platelet transfusion might even cause harm in this context.