Transfusion of Platelets before CVC

Question 1

PACER

Rationale
CVC placement and thrombocytopenia are both common among haematology and ICU patients
Retrospective studies have suggested that with USS guidance CVC insertion is safe even with a platelet count < 20,000 per mm3

Transfusion guidelines for placement of a CVC offer conflicting recommendations regarding transfusion threshold:
<20,000: British Society of Hematology
<40 – 5000: American Society of Oncology
<50,000: AAGBI for “other major surgery or invasive procedures”,

scarce and expensive resource

Various adverse effects include TRALI, TACO, allergic reaction and alloimmunizati

Answer 1

Haematology or ICU patients with platelet counts between 10,000 and 50,000 per mm3,
is receiving no prophylactic platelets NON INFERIOR compared to the administration of 1u platelets in order to reduce the risk of catheter-related bleeding?

Results:

In patients with severe thrombocytopenia, withholding prophylactic platelet transfusion before CVC placement in those with a platelet count of 10,000 to 50,000 mm3 did not meet the predefined margin for non-inferiority, and resulted in more CVC-related bleeding than prophylactic platelet transfusion