Management Guidelines for Thrombocytopenia in Critically Ill

In general, the management of thrombocytopenia is to treat the underlying cause. However, platelet transfusions may be considered if there is active bleeding or if a procedure with bleeding risk is required. The following guidance may be followed for practical purposes:

If platelet count is below 10 × 109/L, one adult dose of platelets may be transfused.

If the platelet count is below 20 × 109/L and patient is septic or very ill, one adult dose of platelets may be       transfused (in these clinical situations, increased platelet consumption can occur).

If the platelet count is below 30 × 109/L and the patient is bleeding, one adult dose of platelets may be transfused.

If the platelet count is over 30 × 109/L, platelet transfusion is avoided unless:

   Patient requires an interventional procedure (threshold is most often 50 × 109/L).

   Patient requires anti-platelet agent (threshold is 50 × 109/L).

In certain conditions like TT P and heparin-induced thrombocytopenia, platelet transfusions are best avoided unless active and life-threatening bleeding occurs.

REFERENCE:

Haematology in Critical Care: A Practical Handbook, First Edition. Edited by Jecko Thachil and Quentin A. Hill.