Blood transfusion

  • NICE guideline
  • NG24
  • Published: 
  • Last updated: 
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Platelet transfusion

People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.

Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Healthcare professionals should follow our general guidelines for people delivering care:

1.7 Thresholds and targets

People with thrombocytopenia who are bleeding

1.7.1

Offer platelet transfusions to people with thrombocytopenia who have clinically significant bleeding (grade 2; see the table on World Health Organization [WHO] Bleeding Grades) – and a platelet count below 30×109 per litre. [2015]

1.7.2

Use higher platelet thresholds (up to a maximum of 100×109 per litre) for people with thrombocytopenia and either of the following:

  • severe bleeding (WHO grades 3 and 4)

  • bleeding in critical sites, such as the central nervous system (including eyes). [2015]

People who are not bleeding or having invasive procedures or surgery

1.7.3

Offer prophylactic platelet transfusions to people with a platelet count below 10×109 per litre who are not bleeding or having invasive procedures or surgery, and who do not have any of the following conditions:

  • chronic bone marrow failure

  • autoimmune thrombocytopenia

  • heparin-induced thrombocytopenia

  • thrombotic thrombocytopenic purpura. [2015]

People who are having invasive procedures or surgery

1.7.4

Consider prophylactic platelet transfusions to raise the platelet count above 50×109 per litre in people who are having invasive procedures or surgery. [2015]

1.7.5

Consider a higher threshold (for example 50 to 75×109 per litre) for people with a high risk of bleeding who are having invasive procedures or surgery, after taking into account:

  • the specific procedure the person is having

  • the cause of the thrombocytopenia

  • whether the person's platelet count is falling

  • any coexisting causes of abnormal haemostasis. [2015]

1.7.6

Consider prophylactic platelet transfusions to raise the platelet count above 100×109 per litre in people having surgery in critical sites, such as the central nervous system (including the posterior segment of the eyes). [2015]

When prophylactic platelet transfusions are not indicated

1.7.7

Do not routinely offer prophylactic platelet transfusions to people with any of the following:

  • chronic bone marrow failure

  • autoimmune thrombocytopenia

  • heparin‑induced thrombocytopenia

  • thrombotic thrombocytopenic purpura. [2015]

1.7.8

Do not offer prophylactic platelet transfusions to people having procedures with a low risk of bleeding, such as adults having central venous cannulation or any people having bone marrow aspiration and trephine biopsy. [2015]

1.8 Doses

1.8.1

Do not routinely transfuse more than a single dose of platelets. [2015]

1.8.2

Only consider giving more than a single dose of platelets in a transfusion for people with severe thrombocytopenia and bleeding in a critical site, such as the central nervous system (including eyes). [2015]

1.8.3

Reassess the person's clinical condition and check their platelet count after each platelet transfusion, and give further doses if needed. [2015]