Around 2 million doses of platelets are given in the United States every year. You might be surprised to know, though, that most are given “just in case.” Dr. Rick Kaufman returns to the podcast to discuss the 2015 AABB Platelet Clinical Practice Guideline.

Dr. Rick Kaufman

Dr. Rick Kaufman

Platelets are tiny little nucleus-free cells that seem to cause more than their fair share of discussions and problems! Most blood bankers believe that we have made less progress in improving platelet transfusion practices than we have made with red blood cell transfusions. To that end, the AABB released a “Clinical Practice Guideline” in 2015 summarizing the evidence surrounding platelet transfusions to date. Today’s guest, Dr. Rick Kaufman, was lead author on that paper.

Dr. Kaufman takes us on a tour of the evidence (such as it is) regarding prophylactic (“just in case”) platelet transfusions, platelet transfusions before minor procedures like central venous catheter insertion and lumbar puncture, major non-neurologic surgery, cardiac surgery with cardiopulmonary bypass, and intracranial hemorrhage in those on anti-platelet medications. What Rick and the other authors found may surprise you!

Speaker Bio:

Dr. Rick Kaufman trained in clinical pathology and completed a transfusion medicine fellowship at Washington University in St. Louis before relocating to Boston. Rick is currently medical director of the Brigham and Women’s Hospital Adult Transfusion Service, and an Associate Professor of Pathology at Harvard. He is a previous guest on this podcast, outlining the potential impact of the drug daratumumab (“DARA”) on blood bank testing in episode 010.

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DISCLAIMER: The opinions expressed on this episode are those of my guest and I alone, and do not reflect those of the organizations with which either of us is affiliated. Neither Dr. Kaufman nor I have any relevant financial disclosures.

The images below are generously provided by Dr. Kaufman.

Slide 1 - AABB recommendation regarding prophylactic platelet transfusion: Use it, and do so at counts of 10K or less.
Slide 2 - Continuation of prophylactic platelets: A single apheresis dose is effective
Slide 3 - For minor invasive procedures, AABB recommends 20K for CVC insertion and 50K for LP
Slide 4 - For major non-neurologic surgery, AABB recommends using a 50K threshold for platelet transfusion
Slide 5 - AABB recommends against giving routine prophylactic platelet transfusions for cardiac bypass, but suggests treating periop bleeding in patients with thrombocytopenia and platelet dysfunction
Slide 6 - AABB could not recommend for or against platelet transfusion for those with intracranial hemorrhage while on antiplatelet therapy (new data available; see below)

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