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

Perioperative Thrombocytopenia

Thrombocytopenia is defined as a platelet count less than 150 × 103 cells/μl. Five to ten percent of patients will be thrombocytopenic preoperatively, and an unknown number will develop thrombocytopenia in the perioperative period.[29] Perioperative thrombocytopenia is usually caused by hemodilution and consumption, but can also be the result of antiplatelet therapy, heparin, other medications, decreased production, increased sequestration, immune destruction, and laboratory artifact.[30] Any degree of preoperative thrombocytopenia is associated with higher odds of transfusion, complications, long-term care, readmission, reoperation, and death in a dose-dependent fashion,[31] and patients who require platelet transfusion also have a higher odds of red cell transfusion, reoperation, and death.[29]

One in three of cases of platelet refractoriness is associated with alloimmunization against donor platelet antigens.[32] The most common alloantibodies are against human leukocyte antigens A or B, and are usually seen in multiparous or multiply transfused patients.[33] Platelet crossmatching, selecting donors with the same antigen phenotype as the patient, or selecting donors who lack the cognate antigens to the patient's antibodies can produce improved platelet increments.[33] All these techniques require additional time and expertise, and advance consultation with transfusion medicine specialists is usually necessary.