Surgical Procedure in a Patient with Thrombocytopenia. When to Transfuse Platelets?

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

A 67-year-old Caucasian male (CM) is admitted to the hospital with an exacerbation of Wegener's granulomatosis. CT scan of the chest shows bilateral nodules. He has a PMH of myelodysplastic syndrome with a platelet count of 11/microL. The patient is scheduled for a bronchoscopy with biopsy of the pulmonary nodules tomorrow.

What is the safe platelet count for a surgical procedure?

In general, a platelet count of 50,000/microL is adequate for most surgical procedures.


How can you increase platelet count in thrombocytopenia?

By transfusing platelets, if the patient is a candidate for such transfusions. For example, patients with immune thrombocytopenia generally do not respond well to platelet transfusions due to rapid destruction by circulating antibodies.

What is the correlation between the number of platelet units transfused and the increase in platelet count?

As a "rule-of-thumb" for most adults, transfusion of six units of platelets (a 6-pack) should raise the platelet count by 25,000/microL.Refractoriness to platelet transfusion is defined as a platelet count increment of less than 5,000.

Six pooled platelet concentrates (a 6-pack) is equivalent to one plateletpheresis concentrate.

What happened?

The patient was transfused 6 units of platelets the day before the procedure and 6 units one hour before the bronchoscopy. The procedure was completed uneventfully.

What did we learn from this case?

Platelet count of 50,000/microL is adequate for most surgical procedures. Transfusion of six units of platelets (a 6-pack) should raise the platelet count by 25,000/microL.

References

Clinical and laboratory aspects of platelet transfusion therapy. UpToDate 14.1 (paid subscription required).
Preoperative management of patients with cancer. UpToDate 14.1 (paid subscription required).
Guidelines for the Management of Platelet Disorders. University of Alabama at Birmingham
Myelodysplastic syndromes: A practical approach to diagnosis and treatment. Cleveland Clinic Journal of Medicine January 2010 vol. 77 1 37-44.

Published: 04/12/2006
Updated: 01/04/2010

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