Platelet Transfusion Guidelines Published

Authors of a special communication published in JAMA provide “updated recommendations” from the 2025 Association for the Advancement of Blood & Biotherapies (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) international clinical practice guidelines for platelet transfusion. The guidelines are meant to serve as, “practical advice on appropriate use of platelets.” The paper noted that the, “primary perspective is the individual patient/family, including medical, psychological, and financial impacts. A secondary perspective is public health, including security of the blood supply. [A systematic review] informed recommendations, with searches of randomized clinical trials (RCTs) and observational studies evaluating platelet transfusions published from 1950 to April 2024.”

The authors of the paper describing the platelet transfusion guidelines of the expert panel further explained that, “[w]hile placing a high value on mortality reduction, the panel accepted the remaining possibility of a small increase in mortality or bleeding with a restrictive strategy.” The paper found that, “that restrictive platelet transfusion strategies probably did not result in important increases in mortality (Absolute risk differences (ARD) ARD, −0.4 percent [95 percent CI, −2.2 percent to 1.7 percent]), World Health Organization (WHO) grade 2-4 bleeding (ARD, 6.8 percent [95 percent CI, 0.9 percent to 12.8 percent]), or WHO grade 3-4 bleeding (ARD, 0.3 percent [95 percent CI, −1.4 percent to 2.4 percent]).”

Platelet transfusion guidelines recommended by the panel include: “Recommendation 1.1: in nonbleeding patients with hypoproliferative thrombocytopenia actively receiving chemotherapy or undergoing allogeneic stem cell transplant, platelet transfusion should be administered when the platelet count is less than 10 × 10³/μL (strong recommendation, moderate-certainty evidence); Recommendation 1.2: in preterm neonates without major bleeding, platelet transfusion should be administered when the platelet count is less than 25 × 10³/μL (strong recommendation, high-certainty evidence); Recommendation 1.3: in patients undergoing lumbar puncture, platelet transfusion should be administered when the platelet count is less than 20 × 10³/μL (strong recommendation, moderate-certainty evidence); and Recommendation 1.4: in patients with Dengue-related consumptive thrombocytopenia in the absence of major bleeding, the panel recommends no platelet transfusion (strong recommendation, moderate-certainty evidence).”

The paper concluded that while, “[r]estrictive transfusion strategies should be implemented, [r]ecommendations may not apply to all individual patient scenarios, as noted in the good practice statement, and for conditional recommendations, clinicians should carefully consider the individual patient’s values and preferences in the decision.” Limitations of the platelet transfusion guidelines outlined in this paper included, “[p]atients with thrombocytopenia are heterogeneous for factors relevant to bleeding risk, which may not be captured by inclusion criteria in trials or baseline features of enrolled patients; [e]vidence in some settings was very low certainty; and [b]aseline risk was not always clear when there was variation in event rates across studies.”

Citation: Metcalf, R.A., Nahirniak, S., Guyatt, G.,  et al. “Platelet Transfusion 2025 AABB and ICTMG International Clinical Practice Guidelines.” JAMA. 2025.