Indications for Platelet Transfusions: How Well Do Physicians Comply with Professional Guidelines

Professional, evidence-based guidelines are developed to help physicians implement best practice care. Unfortunately, guidelines are not followed. Platelet transfusion guidelines have recently changed to a prophylactic transfusion threshold of 10, 000/μ L from the older threshold of 20,000/μ L. We conducted a retrospective analysis at a metropolitan teaching hospital to assess how well physicians comply with the new professional guidelines as well as the older, less stringent criteria to administer platelet transfusions.

All patients admitted to the medical service who received platelet transfusions over a two month period in 2010 were reviewed. These patients represented the following services: ICU, general medicine, medical step down, interventional cardiology, CCU, and the cardiac step down unit. The indication selected in the computerized physician order entry (CPOE) system was compared to the clinical indication found in the patients’ medical record. The medical record clinical indication was then evaluated against the American Society of Hematology (ASH) 2007 “Evidence-Based Platelet Transfusion Guidelines” (Slichter SJ. Hematology 2007): bleeding and platelets ≤50, 000/μ L, pre-invasive procedure and platelets ≤50, 000/μ L, prophylactic transfusion for platelets ≤10, 000/μ L and WHO bleeding grade ≥ 2. We also assessed how the patients’ clinical indication met the older less stringent prophylactic threshold for platelet transfusion of ≤20, 000/μ L laid forth by the landmark study by Gaydos LA. et. al. (The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med 1962).

A total of 108 patients received platelet transfusions; 29 were medicine patients to tally 95 platelet transfusions. The most common patient clinical indication was “platelets ≤ 20, 000/μ L without bleeding” (27%), while the clinical indication was not specified in 16% of cases. The CPOE documented indication coincided with the patient's clinical indication from the medical record in 23% of cases. Sixty five percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 36% of cases failed to meet the older less stringent guidelines.

A majority of platelet transfusions did not meet the current professional guidelines for indication. Our pilot study suggests the need for more physician education regarding evidence-based guidelines for platelet transfusions, and in a larger context, initiatives to enhance compliance. We are currently developing an educational intervention and plan to reassess compliance with indications pre and post intervention.

No relevant conflicts of interest to declare.