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

Thrombocytopenia and Prophylactic Platelet Transfusions Before Neuraxial Anesthesia

The American Society of Anesthesiologists (Schaumburg, Illinois) and the Society for Obstetric Anesthesia and Perinatology (Lexington, Kentucky) do not suggest a platelet count above which it is safe to perform neuraxial anesthesia, although they acknowledge that most providers consider the threshold to be between 75 and 100 × 103 cells/μl.[43] Small observational studies of platelet transfusion to correct thrombocytopenia before neuraxial anesthesia have not detected any benefit, and many patients did not achieve their goal platelet count after transfusion.[13,39] Given the very low baseline rate of severe bleeding complications, it is unlikely that there will ever be definitive trial-level evidence. As with other percutaneous procedures, the anesthesiologist must weigh scant evidence against the clinical needs of the patient.