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Perioperative platelet transfusion: recommendations of the Agence française de sécurité sanitaire des produits de santé (AFSSaPS) 2003

Transfusion périopératoire de plaquettes: recommandations de l’Agence française de sécurité sanitaire des produits de santé (AFSSaPS) 2003

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Abstract

Purpose

To present the recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS; French Safety Agency for Health Products).

Methods

A panel of experts reviewed and graded the literature on platelet transfusions; recommendations were formulated.

Main findings

Threshold platelet counts (PC) for transfusions in the perioperative context have not been clearly defined and should be determined by the existence of hemorrhagic risk factors. In the case of commonly practiced invasive procedures, the recommendation is to transfuse in orderto achieve PC > 50,000 · μL−1. In the absence of platelet dysfunction, regardless of the type of surgery, the standard hemorrhagic riskthreshold for surgery is 50,000 · μL−1. It has not been proven that the risk threshold is different according to the type of surgery. For neurosurgery and ophthalmologic surgery involving the posterior segment of the eye, a PC of 100,000 · μL−1 is required. For axial regional anesthesia, a PC of 50,000 · μL−1 is sufficient for spinal anesthesia; a PC of 80,000 · μL−1 has been proposed for epidurals. During massive transfusion, prophylactic platelet infusion cannot be recommended beyond a loss of two blood volumes in less than 24 hr (Professional Consensus). As for the therapeutic transfusion of plasma and/or platelets, as much as possible, platelet deficit should be documented with test results (PC and fibrinogen) before transfusing. In the event of bleeding, platelet transfusion may precede plasma infusion. However, although this recommendation has been the subject of several professional consensus agreements, it is not based on any randomized studies.

Conclusion

Threshold PC for perioperative transfusions have not been clearly defined and most recommendations are the result of a professional consensus.

Résumé

Objectif

Présenter les recommandations de l’Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS).

Méthode

Un panel d’experts a revu et évalué la documentation sur les transfusions de plaquettes; des recommandations ont été formulées.

Constatations principales

Le décompte plaquettaire seuil (DP) pour les transfusions périopératoires n’est pas clairement défini et doit être déterminé par l’existence de facteurs de risque hémorragique. Dans le cas de gestes invasifs pratiqués fréquemment, on recommande de transfuser pour atteindre un DP > 50 000 · μL−1. En l’absence de dysfonction plaquettaire, peu importe le type de chirurgie, le seuil du risque hémorragique normal de la chirurgie est de 50 000 · μL−1. On n’a pas prouvé que le seuil de risque dépend du type de chirurgie. En neurochirurgie, et ophtalmologique touchant le segment postérieur de l’œil, il faut un DP de 100 000 · μ−1. En anesthésie régionale axiale, un DP de 50 000 · μL−1 est suffisant pour la rachianesthésie; un DP de 80 000 · μL−1 a été proposé pour les péridurales. Pendant la transfusion massive, la perfusion prophylactique de plaquettes ne peut être recommandée au delà d’une perte de deux masses sanguines en moins de 24 h (Consensus professionnel). Comme pour la transfusion thérapeutique de plasma et/ou de plaquettes, autant que possible, le déficit de plaquettes doit être documenté avec les résultats de tests (DP et fibrinogène) avant de transfuser. En cas d’hémorragie, la transfusion de plaquettes peut précéder la transfusion de plasma. Cependant, même si cette recommandation a fait l’objet de certains accords du consensus professionnel, il n’est fondé sur aucune étude randomisée.

Conclusion

Le DP seuil pour les transfusions périopératoires n’a pas été clairement défini et la plupart des recommandations sont le résultat d’un consensus professionnel.

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Correspondence to Charles Marc Samama.

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Samama, C.M., Djoudi, R., Lecompte, T. et al. Perioperative platelet transfusion: recommendations of the Agence française de sécurité sanitaire des produits de santé (AFSSaPS) 2003. Can J Anesth 52, 30–37 (2005). https://doi.org/10.1007/BF03018577

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Keywords

  • Abciximab
  • Fresh Freeze Plasma
  • Platelet Transfusion
  • Eptifibatide
  • Massive Transfusion