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* From the Département d’Anesthésie-Réanimation, Hôpital Avicenne, Bobigny;
Site transfusionnel Saint-Antoine, EFS Ile-de-France, Paris;
Service d’Hématologie Biologique, CHU de Nancy, Nancy;
Département d’Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Universitaire Dupuytren, Limoges; Département d’Hématologie/Biologie, CHU Saint Eloi, Montpellier, France.
Address correspondence to: Pr. Charles Marc Samama, Département d’Anesthésie-Réanimation, Hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny cedex, France. Phone: +33-1-48955591; Fax: +33-1-48955589; E-mail: cmsamama{at}invivo.edu
Purpose: To present the recommendations of the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSaPS; French Safety Agency for Health Products).
Methods: A panel of experts reviewed and graded the literature on platelet transfusions; recommendations were formulated.
Main findings: Threshold platelet counts (PC) for transfusions in the perioperative context have not been clearly defined and should be determined by the existence of hemorrhagic risk factors. In the case of commonly practiced invasive procedures, the recommendation is to transfuse in order to achieve PC > 50,000·µL–1. In the absence of platelet dysfunction, regardless of the type of surgery, the standard hemorrhagic risk threshold for surgery is 50,000·µL–1. It has not been proven that the risk threshold is different according to the type of surgery. For neurosurgery and ophthalmologic surgery involving the posterior segment of the eye, a PC of 100,000·µL–1 is required. For axial regional anesthesia, a PC of 50,000·µL–1 is sufficient for spinal anesthesia; a PC of 80,000·µL–1 has been proposed for epidurals. During massive transfusion, prophylactic platelet infusion cannot be recommended beyond a loss of two blood volumes in less than 24 hr (Professional Consensus). As for the therapeutic transfusion of plasma and/or platelets, as much as possible, platelet deficit should be documented with test results (PC and fibrinogen) before transfusing. In the event of bleeding, platelet transfusion may precede plasma infusion. However, although this recommendation has been the subject of several professional consensus agreements, it is not based on any randomized studies.
Conclusion: Threshold PC for perioperative transfusions have not been clearly defined and most recommendations are the result of a professional consensus.
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