An audit of platelet transfusions at a tertiary care center: New opportunities for patient blood management with the 2025 AABB/ICTMG platelet guidelines

TL;DR

This study audits platelet transfusions at a hospital and finds that new AABB/ICTMG guidelines could reduce unnecessary transfusions.

Contribution

The study evaluates the impact of new 2025 AABB/ICTMG platelet guidelines on transfusion practices at a tertiary care center.

Findings

12.7% of adult and 11.6% of pediatric platelet transfusions were deemed inappropriate by current hospital guidelines.

Applying the new AABB/ICTMG guidelines identified multiple transfusions that would be newly noncompliant.

The new guidelines offer opportunities to reduce unnecessary platelet transfusions in various patient populations.

Abstract

Platelet transfusions are an important tool to prevent and stop bleeding. Thresholds for pretransfusion platelet counts have been studied in various patient populations, yielding evidence‐based guidelines. The Association for the Advancement of Blood and Biotherapies (AABB) collaborated with the International Collaboration for Transfusion Medicine Guidelines (ICTMG) to develop a platelet guideline with new and updated recommendations for different patient populations. The goal of this study was to determine platelet transfusion appropriateness in a large tertiary care hospital, identify common scenarios with deviations from guidelines, and assess the effect that the new AABB/ICTMG guidelines could have on platelet utilization.

A retrospective 8‐week audit of platelet transfusions at a university hospital was conducted using institution‐specific adjudication criteria. A second audit applied the AABB/ICTMG recommendations. Patient demographics, laboratory values, and transfusion details were collected with an electronic audit tool. Each platelet (PLT) order was adjudicated through manual record review.

A total of 1667 units of apheresis PLT were transfused to 312 patients. Using current hospital guidelines, 163 of 1288 adult (12.7%) and 44 of 379 pediatric orders (11.6%) were deemed inappropriate and 119 adult (9.2%) and 24 pediatric (6.3%) orders were indeterminate. The second audit, which applied recommendations from the 2025 AABB/ICTMG platelet guideline, found multiple PLT transfusions that would be newly noncompliant.

There is an incongruency between clinical practice across various specialties and evidence‐based platelet guidelines for platelet transfusions. The new AABB/ICTMG guidelines create an opportunity to reduce unnecessary platelet transfusions in several patient populations.

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