Choosing Wisely:

Don’t transfuse platelets in an asymptomatic (i.e., nonbleeding) pediatric patient (e.g., aplastic anemia, leukemia), with a platelet count > 10,000/mcL unless other signs and/or symptoms for bleeding are present, or if the patient is to undergo an invasive procedure.

Rationale and Comments: In asymptomatic (i.e., nonbleeding) pediatric patients with a platelet count > 10,000/mcL, transfusion is not clinically indicated unless signs, symptoms, or increased risk factors of bleeding are present. This practice is consistent with recommendations from the clinical guidelines of multiple associations (National Institute for Health and Care Excellence, British Society for Haematology, American Society of Clinical Oncology, and American Society of Hematology). The risk of spontaneous bleeding is low at platelet counts > 10,000/mcL. Unnecessary transfusions put patients at risk for transfusion reactions, alloimmunization, blood-borne infections, and refractoriness to future platelet transfusions. This recommendation does not apply in anticipation of an invasive procedure.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Rheumatology
  • Sources:
  • American Society of Clinical Oncology guideline
  • National Institute for Health and Clinical Excellence guidelines
  • Disciplines:
  • Pediatric
  • Hematologic
  • References: • National Institute for Health and Care Excellence. Blood transfusion NICE guideline 24. 2015 Nov. Retrieved from www.nice.org.uk/guidance/ng24.
    • Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr., Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011 Apr;117(16):4190–4207.
    • New HV, Berryman J, Bolton-Maggs PH, Cantwell C, Chalmers EA, Davies T, Gottstein R, Kelleher A, Kumar S, Morley SL, Stanworth SJ. Guidelines on transfusion for fetuses, neonates and older children. British Journal of Haematology. 2016 Nov;175(5):784-828.
    • Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet transfusion for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. Journal of Clinical Oncology. 2018 Jan;36(3):283-299.

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