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Heghine Khachatryan: Patient Safety and Clinical Judgment in Platelet Transfusion Decisions
Heghine Khachatryan/LinkedIn
Oct 25, 2026, 16:26

Heghine Khachatryan: Patient Safety and Clinical Judgment in Platelet Transfusion Decisions

Heghine Khachatryan, Editor-in-Chief of Hemostasis Today, Head of Hemophilia and Thrombosis Center at Yeolyan Hematology and Oncology Center, shared a post on LinkedIn about a recent article by Ryan A. Metcalf et al, published in JAMA, adding:

”Platelet Transfusion: From Evidence to Clinical Decisions

Published in JAMA, the 2025 AABB and ICTMG International Clinical Practice Guidelines provide an evidence-based framework for platelet transfusion. Drawing on 21 randomized controlled trials and 13 observational studies, the guidelines generally support a restrictive transfusion strategy.

Key Clinical Recommendations

The following thresholds are supported by strong recommendations:

  • A platelet count below 10 billion per liter in nonbleeding patients with hypoproliferative thrombocytopenia receiving chemotherapy or undergoing allogeneic stem cell transplantation.
  • A platelet count below 20 billion per liter before lumbar puncture.
  • A platelet count below 25 billion per liter in preterm neonates without major bleeding.

Conditional Recommendations for Adults

  • Central venous catheter placement at anatomically compressible sites: Transfuse when the platelet count is below 10 billion per liter.
  • Interventional radiology procedures: Transfuse when the platelet count is below 20 billion per liter for low-risk procedures and below 50 billion per liter for high-risk procedures.
  • Major nonneuraxial surgery: Transfuse when the platelet count is below 50 billion per liter.
  • Autologous stem cell transplantation or aplastic anemia: A strategy without prophylactic platelet transfusion is recommended for nonbleeding adults.
  • Nonoperative intracranial hemorrhage: Platelet transfusion is not recommended when the platelet count exceeds 100 billion per liter, including in patients receiving antiplatelet agents.

Applying these thresholds requires comprehensive clinical assessment. Decisions should incorporate bleeding severity, the underlying condition, medications, procedural risk, and patient preferences. Conditional recommendations require particularly careful interpretation because of the limited certainty of the available evidence.

Patient safety, thoughtful assessment of expected benefits, and responsible stewardship of donated blood components are essential elements of good transfusion practice.”

Title: Platelet Transfusion2025 AABB and ICTMG International Clinical Practice Guidelines

Authors: Ryan A. Metcalf, Susan Nahirniak, Gordon Guyatt, Aarti Bathla, Sandra K. White, Arwa Z. Al-Riyami, Rachel C. Jug, Ursula La Rocca, Jeannie L. Callum, Claudia S. Cohn, Abe DeAnda, Robert A. DeSimone, Allan Dubon, Lise J. Estcourt, Daniela C. Filipescu, Mark K. Fung, Ruchika Goel, Aaron S. Hess, Heather A. Hume, Richard M. Kaufman, Peter Kranke, Vernon J. Louw, Morten H. Møller, Michael F. Murphy, Jennifer A. Muszynski, Cian J. O’Kelly, Monica B. Pagano, Gopal K. Patidar, Katerina Pavenski, Jacqueline N. Poston, Nabiha H. Saifee, Moritz Stolla, Zbigniew M. Szczepiorkowski, Aaron A.R. Tobian, Raman Uberoi, Jonathan Waters, Brittney Williams, Erica M. Wood, Nicole D. Zantek, Michelle P. Zeller, Brenda J. Grossman, Simon J. Stanworth

Heghine Khachatryan: Patient Safety and Clinical Judgment in Platelet Transfusion Decisions

Other posts featuring Heghine Khachatryan on Hemostasis Today.

Aaron A.R. Tobian Aaron S. Hess Aarti Bathla Abe DeAnda Allan Dubon Arwa Z. Al-Riyami Brenda J. Grossman Brittney Williams Cian J. O’Kelly Claudia S. Cohn Daniela C. Filipescu Erica M Wood Gopal K. Patidar Gordon Guyatt Health Heather A. Hume Heghine Khachatryan Hematology Hemostasis Hemostasis News Hemostasis Today Jacqueline N. Poston Jeannie L. Callum Jennifer A. Muszynski Jonathan Waters Katerina Pavenski Lise J. Estcourt Mark K. Fung Medicine Michael F. Murphy Michelle P. Zeller Monica B. Pagano Moritz Stolla Morten H. Møller Nabiha H. Saifee Nicole D. Zantek Peter Kranke Rachel C. Jug Raman Uberoi Richard M. Kaufman Robert A. DeSimone Ruchika Goel Ryan A. Metcalf Sandra K. White Simon J. Stanworth Susan Nahirniak Ursula La Rocca Vernon J. Louw Zbigniew M. Szczepiorkowski
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