Critical Matters Transfusion of platelets and FFP in the ICU
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Jul 9, 2025 Dr. Angel Coz Yataco, a practicing pulmonary critical care physician and lead author of the latest guidelines from the American College of Chest Physicians, joins the discussion on transfusion practices in the ICU. He delves into the complexities and inconsistencies in platelet and fresh frozen plasma transfusions, advocating for evidence-based, personalized approaches based on individual patient needs. The conversation also emphasizes humility in medicine and the intriguing concept of 'aggressive waiting' in patient care, underscoring the delicate balance between intervention and observation.
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Platelet Transfusion Thresholds
- The platelet transfusion threshold is generally 10,000/µL for critically ill patients without high bleeding risk.
- For patients with high bleeding risk, a target platelet count of 30,000–50,000/µL is reasonable to prevent catastrophic bleeding.
Assess Bleeding Severity Carefully
- Evaluate bleeding severity objectively before deciding on platelet transfusion.
- Use local measures like compression for minor bleeds and consider transfusion when bleeding causes instability or requires red blood cell transfusion.
Avoid Routine Pre-Procedure Transfusions
- Do not routinely transfuse platelets or FFP before central or arterial line placement.
- Assess patient-specific bleeding risk and procedural factors to guide transfusion decisions.
