While platelet transfusions may be necessary to treat conditions like fetal and neonatal alloimmune thrombocytopenia (FNAIT), it should be administered sparingly in line with sound clinical assessments, according to new guidelines recently published in JAMA.
Platelet transfusions can be used to quickly raise platelet levels and stem bleeding in disorders that result in a low platelet count, such as FNAIT. However, as with all forms of blood transfusions, platelet transfusions are not without the risk of adverse events.
The American Association of Blood Banks (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) commissioned a set of guidelines to enhance clinical decision-making in terms of the use of platelet transfusions to deal with related diseases. An expert panel with previous experience in developing guidelines was assembled. The evidence-gathering process included a systematic review of available studies on this subject, as well as a survey of ICTMG members regarding treatment outcomes and experience with significant bleeding.
After a process of fact-finding, the panel grouped their recommendations into two categories: strong recommendations and conditional recommendations.
Read more about FNAIT testing and diagnosis
One of the “strong” recommendations particularly relevant in FNAIT is that platelet transfusions should be considered in preterm newborns without evidence of major bleeding if the platelet count falls below 25 x 103/μL. The reason for this is that the panel believed that a more cautionary approach to platelet transfusions best serves the interest of the patient, which in this case means setting a reasonable threshold for the administration of platelet transfusions.
As for the “conditional” recommendations offered by the expert panel, 6 of the 7 recommendations specifically referred to adult patients, while one recommendation described the withholding of platelet transfusions in patients undergoing cardiovascular surgery if they do not have major bleeding or evidence of a low platelet count. Again, the underlying rationale for these recommendations is to limit the occurrence of adverse events associated with unnecessary platelet transfusions.
“Restrictive [as opposed to liberal] transfusion strategies should be implemented,” the expert panel concluded. “Recommendations may not apply to all individual patient scenarios . . . and for conditional recommendations, clinicians should carefully consider the individual patient’s values and preferences in the decision.”
Sign up here to get the latest news, perspectives, and information about FNAIT sent directly to your inbox. Registration is free and only takes a minute.
