Adopting the updated guidelines for platelet transfusions, which were recently released by The Association for the Advancement of Blood and Biotherapies (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG), may help reduce unnecessary platelet transfusions, according to a recent study published in Transfusion.
Platelet transfusions are commonly used to treat fetal and neonatal alloimmune thrombozytopenia (FNAIT), as well as hypoproliferative and consumptive thrombocytopenia.
The authors aimed to conduct a retrospective audit of all platelet transfusions at a university hospital using the institution’s existing guidelines to establish baseline appropriateness, then re-evaluate the same transfusions against the newly released 2025 AABB/ICTMG platelet transfusion recommendations to identify common deviations, quantify potential reductions in platelet utilization and highlight new opportunities for patient blood management and education across clinical services.
The study retrospectively reviewed approximately 1700 apheresis platelet units transfused to almost 320 patients over eight weeks in 2024, extracting demographic, laboratory and clinical data from electronic records and manually adjudicating each order against hospital guidelines and then against selected 2025 AABB/ICTMG recommendations.
Outcomes showed that around 80% of transfusions in adults and almost 82% of transfusions in pediatrics were deemed appropriate according to hospital rules. A re-audit with new guidelines changed many previously appropriate transfusions to non-compliant. Limitations include reliance on laboratory values without a full clinical context or bleeding documentation.
The authors stated future audits could be strengthened by prospective design, integration of thromboelastography results when available, clearer risk stratification for interventional procedures and real-time clinical decision support tools.
“The audits in this study have demonstrated the potential effect the new AABB/ICTMG guidelines could have on platelet use in large tertiary centers…These steps will likely reduce platelet usage and, in some cases, will also improve patient safety and outcomes,” the authors wrote.
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