Abstract
Acquired platelet abnormalities may result from a change in platelet number or platelet function. Thrombocytopenia is common in critically unwell patients, and causes are often multifactorial in nature. Up to one quarter of critically ill patients receive a platelet transfusion, usually to prevent rather than to treat bleeding. There are several guidelines to help guide clinicians make platelet transfusion decisions, but little is currently understood about the association between absolute platelet number, in vivo platelet function and overall bleeding risk. This chapter summarises the current and limited evidence for prophylactic platelet transfusion triggers in different clinical scenarios in critically unwell adults, children and neonates. Platelet transfusions are biological agents and not without risk. A main treatment for acquired platelet abnormalities remains management of the underlying disorder.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hui P, Cook DJ, Lim W, Fraser GA, Arnold DM. The frequency and clinical significance of thrombocytopenia complicating critical illness: a systematic review. Chest. 2011;139(2):271–8.
Lieberman L, Bercovitz RS, Sholapur NS, Heddle NM, Stanworth SJ, Arnold DM. Platelet transfusions for critically ill patients with thrombocytopenia. Blood. 2014;123(8):1146–51. doi:10.1182/blood-2013-02-435693; quiz 1280. Epub 2013 Dec 12.
Roberts I, Stanworth S, Murray NA. Thrombocytopenia in the neonate. Blood Rev. 2008;22(4):173–86.
Stanworth SJ, Walsh TS, Prescott RJ, et al. Thrombocytopenia and platelet transfusion in UK critical care: a multicenter observational study. Transfusion. 2013;53(5):1050–8.
Arnold DM, Crowther MA, Cook RJ, et al. Utilization of platelet transfusions in the intensive care unit: indications, transfusion triggers, and platelet count responses. Transfusion. 2006;46(8):1286–91. [Erratum appears in Transfusion. 2009;49(9):2012].
Stephan F, De Montblanc J, Cheffi A, Bonnet F. Thrombocytopenia in critically ill surgical patients: a case-control study evaluating attributable mortality and transfusion requirements. Crit Care. 1999;3(6):151–8.
Stephan F, Hollande J, Richard O, Cheffi A, Maier-Redelsperger M, Flahault A. Thrombocytopenia in a surgical ICU. Chest. 1999;115(5):1363–70.
Thomas L, Kaidomar S, Kerob-Bauchet B, et al. Prospective observational study of low thresholds for platelet transfusion in adult dengue patients. Transfusion. 2009;49(7):1400–11.
McIntyre L, Tinmouth AT, Fergusson DA. Blood component transfusion in critically ill patients. Curr Opin Crit Care. 2011;19(4):326–33.
Bolton-Maggs PHB, editor, Poles D, Watt A, Thomas D, Cohen H, on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group. The 2012 annual SHOT report. 2013.
Stanworth SJ, Estcourt LJ, Powter G, Kahan BC, Dyer C, Choo L, Bakhrania L, Llewelyn C, Bielby L, Norfolk D, Wood EM, Murphy MF. The effect of a no-prophylactic versus prophylactic platelet transfusion strategy on bleeding in patients with hematological malignancies and severe thrombocytopenia (TOPPS trial). A randomized controlled, non-inferiority trial. N Engl J Med. 2013;368(19):1771–80.
Wandt H, Schaefer-Eckart K, Wendelin K, et al. Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: an open-label, multicentre, randomised study. Lancet. 2012;380(9850):1309–16.
British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol. 2003;122(1):10–23.
Association of Anaesthetists of Great Britain and Ireland, Obstetric Anaesthetists’ Association, Regional Anaesthesia UK. Regional anaesthesia and patients with abnormalities of coagulation. Anaesthesia. 2013;68:966–72.
Association of Anaesthetists of Great Britain and Ireland. Blood transfusion and the anaesthetist. 2005. http://www.aagbi.org/sites/default/files/bloodtransfusion06.pdf. Accessed 12/03/14.
Association of Anaesthetists of Great Britain and Ireland. Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia. 2010;65:1153–61.
Miller TE. New evidence in trauma resuscitation – is 1:1:1 the answer? Perioper Med (Lond). 2013;2(1):13.
Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
Strauss R, Wehler M, Mehler K, Kreutzer D, Koebnick C, Hahn EG. Thrombocytopenia in patients in the medical intensive care unit: bleeding prevalence, transfusion requirements, and outcome. Crit Care Med. 2002;30(8):1765–71.
Andrew M, Vegh P, Caco C, et al. A randomized, controlled trial of platelet transfusions in thrombocytopenic premature infants. J Pediatr. 1993;123(2):285–91.
Stanworth SJ, Clarke P, Watts T, et al. Prospective, observational study of outcomes in neonates with severe thrombocytopenia. Pediatrics. 2009;124(5):e826–34.
Bonifacio L, Petrova A, Nanjundaswamy S, Mehta R. Thrombocytopenia related neonatal outcome in preterms. Indian J Pediatr. 2007;74(3):269–74.
Dohner ML, Wiedmeier SE, Stoddard RA, et al. Very high users of platelet transfusions in the neonatal intensive care unit. Transfusion. 2009;49(5):869–72.
Garcia MG, Duenas E, Sola MC, Hutson AD, Theriaque D, Christensen RD. Epidemiologic and outcome studies of patients who received platelet transfusions in the neonatal intensive care unit. J Perinatol. 2001;21(7):415–20.
Gerday E, Baer VL, Lambert DK, et al. Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit. Transfusion. 2009;49(10):2034–9.
Kahn DJ, Richardson DK, Billett HH. Inter-NICU variation in rates and management of thrombocytopenia among very low birth-weight infants. J Perinatol. 2003;23(4):312–6.
Murray NA, Howarth LJ, McCloy MP, Letsky EA, Roberts IAG. Platelet transfusion in the management of severe thrombocytopenia in neonatal intensive care unit patients. Transfus Med. 2002;12(1):35–41.
Muthukumar P, Venkatesh V, Curley A, et al. Severe thrombocytopenia and patterns of bleeding in neonates: results from a prospective observational study and implications for use of platelet transfusions. Transfus Med. 2012;22(5):338–43.
Gibson BE, Todd A, Roberts I, et al. Transfusion guidelines for neonates and older children. Br J Haematol. 2004;124(4):433–53.
Poterjoy BS, Josephson CD. Platelets, frozen plasma, and cryoprecipitate: what is the clinical evidence for their use in the neonatal intensive care unit? Semin Perinatol. 2009;33(1):66–74.
Agrawal S, Sachdev A, Gupta D, Chugh K. Platelet counts and outcome in the pediatric intensive care unit. Indian J Crit Care Med. 2008;12(3):102–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Garry, D., Mckechnie, S., Stanworth, S.J. (2015). Platelet Transfusion Trigger in the Intensive Care Unit. In: Juffermans, N., Walsh, T. (eds) Transfusion in the Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-319-08735-1_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-08735-1_13
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-08734-4
Online ISBN: 978-3-319-08735-1
eBook Packages: MedicineMedicine (R0)