Supportive strategies in thrombocytopenia: Platelet transfusion and beyond

Thrombocytopenia is a frequent hematological disorder associated with an increased risk of bleeding across diverse clinical settings. Supportive management aims to prevent hemorrhagic complications, relieve symptoms, and address underlying causes. This narrative review summarizes evidence from randomized trials, systematic reviews, and international guidelines on the supportive management of thrombocytopenia in hematological, oncological, surgical, and critical care settings. Platelet transfusion remains the cornerstone of supportive treatment in patients with severe thrombocytopenia or active bleeding. Prophylactic transfusion is generally recommended in high-risk patients with bone marrow suppression, although thresholds vary according to clinical context and bleeding risk. Therapeutic transfusion is indicated in the presence of active bleeding or prior to urgent procedures. Adjunctive hemostatic therapies may provide additional benefit in selected scenarios. In many clinical situations, recommendations are based on limited evidence, supporting an individualized and restrictive transfusion approach.