Indications for Platelet Transfusions: How Educational Interventions Can Improve Compliance with National Guidelines

Evidence-based guidelines are developed and promoted to help physicians implement best practice care. The American Society of Hematology (ASH) platelet transfusion guidelines changed in 2007 to a prophylactic transfusion threshold of 10, 000/μL from the previous 20,000/μL. We conducted a retrospective analysis at a metropolitan teaching hospital to assess how well physicians are complying with the new professional guidelines as well as the older, less stringent criteria to administer platelet transfusions. We then assessed the effect of an educational intervention on transfusion practices.

All patients receiving platelet transfusions over a five-month period from Jan-Feb, and April-June 2010, admitted to the medical, critical care and cardiac services were reviewed. The medical record clinical indication was then evaluated against the ASH 2007 “Evidence-Based Platelet Transfusion Guidelines” (Slichter SJ. Hematology 2007): bleeding and platelets ≤50, 000/μL, pre-invasive procedure and platelets ≤50, 000/μL, prophylactic transfusion for platelets ≤10, 000/μL and WHO bleeding grade ≥ 2. We also assessed how the patients’ clinical indication met the previous prophylactic threshold for platelet transfusion of ≤20, 000/μL 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).

Following initial data collection, we implemented an educational intervention by giving a lecture, reviewing all indications for platelet transfusions, and distributing a pocket card to the house-staff on the medical wards in August, 2010. We subsequently gathered post-intervention data following the methods described above for four consecutive months from Sept-December, 2011.

Eighty-six patients on the selected units received a total of 241 platelet transfusions. Fifty nine percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 37% of cases failed to meet even the older guideline.

Eighty-one patients received a total of 237 platelet transfusions post-intervention. Forty-seven percent of the time the patient's clinical indication failed to meet the currently accepted 2007 ASH guidelines and 19% of cases failed to meet the older guideline.

Based on the significant difference observed between the pre- and post-educational intervention groups, our initial study shows that updating physicians on current evidence-based guidelines for platelet transfusions is a simple and effective means to improve transfusion practices. Periodic educational interventions may prove to even further enhance physician compliance with up-to-date guidelines and we plan to implement additional educational interventions throughout the upcoming academic year.

No relevant conflicts of interest to declare.