Perioperative Platelet Transfusions

Aaron Stansbury Hess, M.D., Ph.D.; Jagan Ramamoorthy, M.D.; John Rider Hess, M.D., M.P.H.


Anesthesiology. 2021;134(3):471-479. 

In This Article

Therapeutic Platelet Transfusion for Bleeding After Cardiopulmonary Bypass

Cardiopulmonary bypass causes a transient platelet dysfunction associated with the selective release of platelet alpha-granule contents, which include factor V, von Willebrand factor, and fibrinogen.[1,47] It was once common practice to prophylactically transfuse platelets before separation from bypass, but many societies explicitly recommend against this practice, and suggest that platelets should not be transfused to patients with a platelet count above 50 × 103 cells/μl who do not exhibit perioperative bleeding.[38] In those who do bleed, however, platelet transfusion seems beneficial: in a subgroup analysis of 324 patients enrolled in the Red Cell Storage Duration Study who had massive transfusion during cardiac surgery, patients given higher ratios of platelets to red cells had greater improvement in their Multiple Organ Dysfunction Score compared with patients who received lower ratios.[48] The Society of Cardiovascular Anesthesiologists (East Dundee, Illinois) suggests that platelets are indicated for bleeding patients with a count less than 50 × 103 cells/μl, and that they may be indicated for patients with a count between 50 and 100 × 103 cells/μl, but that transfusion should be guided by predefined, laboratory-guided algorithms.[49] The empiric use of 1-deamino-8-D-arginine-vasopressin to reverse cardiopulmonary bypass-associated platelet dysfunction does not significantly reduce transfusion requirements.[50] As noted, there is significant variability in transfusion rates among surgeons and anesthesiologists in cardiac surgery, even when controlling extensively for patient and procedural factors.[15,16]