A dose of platelets: getting it just right

Abstract: Platelet transfusions are commonly administered to patients with thrombocytopenia, hemorrhage and platelet dysfunction. Although the optimal threshold for transfusion and the appropriate number of platelets per dose are not defined in all clinical situations, a platelet count of 10,000/µL is a generally accepted threshold for prophylactic transfusions in uncomplicated patients. Meanwhile, the minimum yield for collection or the size of a standard dose is higher in the United States under the Food and Drug Administration regulatory requirements than in European nations and in Canada. Given the challenges in maintaining donor recruitment and product supplies, minimal yield specifications have come under scrutiny, and utilization criteria for platelet products have come under investigation with evidence that many prophylactic platelet transfusions are administered to patients when their counts are above the recommended guideline threshold without evidence of bleeding. These findings suggest that there are opportunities to improve practices surrounding platelet collections and transfusion practices, reducing platelet dosages and number of transfusions administered, that would positively affect the availability of platelet products in the face of severe supply shortages and avoid platelet transfusions that provide little to no significant clinical benefit to patients and potentially cause more harm than good.