An audit of platelet transfusions at a tertiary care center: New opportunities for patient blood management with the 2025 AABB/ICTMG platelet guidelines

Background: Platelet transfusions are an important tool to prevent and stop bleeding. Thresholds for pretransfusion platelet counts have been studied in various patient populations, yielding evidence-based guidelines. The Association for the Advancement of Blood and Biotherapies (AABB) collaborated with the International Collaboration for Transfusion Medicine Guidelines (ICTMG) to develop a platelet guideline with new and updated recommendations for different patient populations. The goal of this study was to determine platelet transfusion appropriateness in a large tertiary care hospital, identify common scenarios with deviations from guidelines, and assess the effect that the new AABB/ICTMG guidelines could have on platelet utilization. Study Design and Methods: A retrospective 8-week audit of platelet transfusions at a university hospital was conducted using institution-specific adjudication criteria. A second audit applied the AABB/ICTMG recommendations. Patient demographics, laboratory values, and transfusion details were collected with an electronic audit tool. Each platelet (PLT) order was adjudicated through manual record review. Results: A total of 1667 units of apheresis PLT were transfused to 312 patients. Using current hospital guidelines, 163 of 1288 adult (12.7%) and 44 of 379 pediatric orders (11.6%) were deemed inappropriate and 119 adult (9.2%) and 24 pediatric (6.3%) orders were indeterminate. The second audit, which applied recommendations from the 2025 AABB/ICTMG platelet guideline, found multiple PLT transfusions that would be newly noncompliant. Discussion: There is an incongruency between clinical practice across various specialties and evidence-based platelet guidelines for platelet transfusions. The new AABB/ICTMG guidelines create an opportunity to reduce unnecessary platelet transfusions in several patient populations.