Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines.

Area of Science:

• Hematology
• Transfusion Medicine
• Clinical Practice Guidelines

Background:

• Platelet transfusion is a common medical procedure with associated benefits and risks.
• Evidence-based guidelines are needed to optimize platelet transfusion practices in adult and pediatric populations.

Purpose of the Study:

• To develop recommendations for platelet transfusion strategies in adult and pediatric patients.
• To compare restrictive versus liberal platelet transfusion approaches.

Main Methods:

• Systematic review and meta-analysis of 21 randomized trials and 13 observational studies.
• Application of the Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology.
• Comparison of transfusion strategies based on platelet counts and clinical context.

Main Results:

• Restrictive transfusion strategies were found to be non-inferior to liberal strategies regarding mortality and bleeding.
• Specific platelet count thresholds for transfusion were recommended for various conditions, including chemotherapy, stem cell transplant, dengue, and surgical procedures.
• Platelet transfusion is not recommended for nonoperative intracranial hemorrhage with platelet counts >100 × 10^3/μL or for cardiovascular surgery without major hemorrhage.

Conclusions:

• Restrictive platelet transfusion strategies are supported by consistent evidence and offer advantages in reducing adverse reactions, mitigating shortages, and lowering costs.
• Clinical context and alternative therapies should be considered when making decisions about platelet transfusion.
• These recommendations provide practical guidance for optimizing patient care and resource utilization in transfusion medicine.