Platelet transfusion trigger in difficult patients

There is general consensus that a prophylactic pre-transfusion trigger at 1 0.000 platelets/muL in stable oncohematological patients is as safe as the traditional trigger of 20.000/muL, and that perioperative triggers at 50.00 0 and 100.000/muL are adequate in most surgical and neurosurgical condition s respectively. Guidelines on the trigger and other issues related to plate let transfusion can be found in nine documents published during 1987-2001 b y the National Institutes of Health (NIH), the British Committee on Standar dization in Hematology, the Royal College of Physicians of Edinburgh, the C ollege of American Pathologists, the American Society of Anesthesiology and the American Society of Clinical Oncology (ASCO). Although consensus may b e less evident on specific triggers for 'difficult' patients, the following triggers, listed by progressively increasing levels, have been proposed in the literature and have found general agreement: a stable oncohematologica l recipient: 10.000; lumbar puncture in a stable pediatric leukemic patient : 10.000; heparin-induced thrombocytopenia: 10.000; bone marrow aspiration and biopsy: 20.000; gastrointestinal endoscopy in cancer: 20.000-40.000; di sseminated intravascular coagulation: 20.000-50.000; fiber-optic bronchosco py in a bone marrow transplant recipient: 20.000-50.000; neonatal alloimmun e thrombocytopenia: 30.000; major surgery in leukemia: 50.000; thrombocytop enia secondary to massive transfusion: 50.000; invasive procedures in cirrh osis: 50.000; cardiopulmonary bypass: 50.000-60.000; liver biopsy: 50.000-1 00.000; a nonbleeding premature infant: 60.000; neurosurgery: 100.000. The proposed values must be considered within the context of careful clinical e valuation of each individual patient, and attention should be given to the power of discrimination of platelet counters at low counts and to the promp t availability of good quality platelet products in the case of emergency. (C) 2001 Editions scientifiques et medicales Elsevier SAS.