Rebulla et al listed criteria for when to administer platelet products prophylactically in a patient being treated for acute myeloid leukemia (AML). These criteria can help reduce the use of platelet products in these patients. The authors are from the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto.


The previous threshold used for administering prophylactic platelet transfusion in patients with AML receiving chemotherapy was 20,000 per µL.


The platelet level associated with spontaneous hemorrhage in a stable patient with no other hemorrhagic risk factors is 5,000 per µL. The threshold for prophylactic transfusion was raised to 10,000 per µL because:

(1) some automated analyzers may not be accurate at low platelet counts

(2) platelet products may not always be readily available, so a safety margin is helpful.


If a patient had one or more risk factors for bleeding, then a threshold of 20,000 per µL was used. These conditions included:

(1) fever > 38°C

(2) active bleeding

(3) invasive procedure contemplated

Other authors also included (Gmur et al, Wandt et al):

(4) coagulation disorder or DIC

(5) receiving heparin therapy

(6) white blood cell count > 50,000 per µL

(7) acute promyelocytic leukemia

(8) receiving drugs affecting platelet function


Using a lower threshold for prophylactic platelet transfusion reduced transfusions by 21.5% with no significant impact on outcomes.


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