ABSTRACT
Indications There is no scientific basis for the old “20,000/μ ι ” cut-off for the transfusion of
platelets. Risk of spontaneous severe bleeding rises only when the platelet count is below 5,000/μ ί. Risk o f intracranial hemorrhage is highest only when the count is below 1,000/μ ι (risk 0.76%/day). The Gmur study demonstrated a rate of major bleeding of 0.07%/day when platelets counts were 10-20,000/μΚ This risk of ma jor bleeding rose to 1.9%/study day when platelet counts were less than ΙΟ,ΟΟΟ/μί. Patients with chronic autoimmune thrombocytopenia can tolerate platelet counts in the 5-10,000/μ ι range for years. Considerable data from randomized trials now indicates that, for oncology patients, a transfusion trigger o f ΙΟ,ΟΟΟ/μί is sufficient to prevent thrombocytopenic bleeding. There are trials suggesting that one can even eliminate"prophylactic” platelet transfusions. However, these trials only eliminated transfusions for very stable patients-no fevers, petechia, etc... and the applicability o f this approach to usual clinical practice is uncertain.
