Thresholds for platelet transfusion in critical illness21,38,42
| Indication . | Platelet threshold* . | Strength of recommendation . | Quality of evidence . |
|---|---|---|---|
| Severe bleeding | Maintain PLT > 50 × 109/L; consider using an MTP | Strong | Low |
| Prophylaxis in adults | 10 × 109/L | Moderate | Low |
| Prior to elective central venous catheter | 20 × 109/L† | Weak | Low |
| Prior to chest tube insertion or thoracentesis | 50 × 109/L | Weak | Low |
| Prior to bronchoscopy with lavage | 20 × 109/L | Weak | Low |
| Prior to paracentesis | Not routinely required | Weak | Low |
| Prior to bone marrow biopsy | Not routinely required | Weak | Low |
| Prior to elective diagnostic lumbar puncture | 50 × 109/L | Weak | Very low |
| Prior to urgent diagnostic lumbar puncture | 20 × 109/L | Weak | Very low |
| Prior to major elective surgery (excluding neurosurgery) | 50 × 109/L | Weak | Very low |
| Prior to neurosurgery | 100 × 109/L | Weak | Very low |
| Traumatic brain injury, intracranial hemorrhage | 100 × 109/L | Weak | Low |
| Prior to insertion of an intraventricular drain | 100 × 109/L | Weak | Very low |
| Indication . | Platelet threshold* . | Strength of recommendation . | Quality of evidence . |
|---|---|---|---|
| Severe bleeding | Maintain PLT > 50 × 109/L; consider using an MTP | Strong | Low |
| Prophylaxis in adults | 10 × 109/L | Moderate | Low |
| Prior to elective central venous catheter | 20 × 109/L† | Weak | Low |
| Prior to chest tube insertion or thoracentesis | 50 × 109/L | Weak | Low |
| Prior to bronchoscopy with lavage | 20 × 109/L | Weak | Low |
| Prior to paracentesis | Not routinely required | Weak | Low |
| Prior to bone marrow biopsy | Not routinely required | Weak | Low |
| Prior to elective diagnostic lumbar puncture | 50 × 109/L | Weak | Very low |
| Prior to urgent diagnostic lumbar puncture | 20 × 109/L | Weak | Very low |
| Prior to major elective surgery (excluding neurosurgery) | 50 × 109/L | Weak | Very low |
| Prior to neurosurgery | 100 × 109/L | Weak | Very low |
| Traumatic brain injury, intracranial hemorrhage | 100 × 109/L | Weak | Low |
| Prior to insertion of an intraventricular drain | 100 × 109/L | Weak | Very low |
MTP, massive transfusion protocol; PLT, platelet count.
May be modified by several factors including platelet dysfunction or other risk factors for bleeding, indication for the procedure, urgency, and medical comorbidities.
Inserted with bedside ultrasound and by experienced personnel. Avoid noncompressible vessels if platelets are <50 × 109 per liter. Choosing a compressible site is preferable to platelet transfusion.