Patient Blood Management Guidelines: Module 2

Perioperative

Contents

3.7 Triggers for blood component transfusion

Question 9 (Prognostic) GNQ6

In patients undergoing surgery, at what INR (PT/APTT) for FFP, fibrinogen level for cryoprecipitate and platelet count for platelet concentrates should patients be transfused to avoid risks of significant adverse events?

APTT, activated partial thromboplastin time; FFP, fresh frozen plasma; INR, international normalised ratio; PT, prothrombin time

The systematic review identified 16 relevant studies (6 Level II and 10 Level III, of fair to good quality) examining the effect of abnormal coagulation parameters on outcomes in patients undergoing surgery or invasive procedures.241–255 These studies included a diverse range of invasive procedures, including biopsies (visceral, endoscopic and laparoscopic), central venous cannulation, lumbar puncture, nephrostomy and femoral arteriography. There was insufficient evidence to define a threshold platelet count, fibrinogen level or INR that is associated with significant adverse events.241–255 Worsening thrombocytopenia may be associated with an increase in minor bleeding complications.242,243,248,252,256 Appendix E provides blood component information and dosage, for use if a decision is made to transfuse blood components.

EVIDENCE STATEMENT – triggers for blood component transfusion Evidence Consistency Cinical impact Generalisability Applicability
In patients undergoing invasive procedures, including biopsies (visceral, endoscopic and laparoscopic), central venous cannulation, lumbar puncture, nephrostomy and femoral arteriography, there is insufficient evidence to define a threshold platelet count, fibrinogen level or INR that is associated with significant adverse events. Worsening thrombocytopenia may be associated with an increase in minor bleeding complications. X

INR, international normalised ratio

3 ticks = A; 2 ticks B; 1 tick = C; X = D; NA = not applicable (See Table 2.2)

PRACTICE POINTS – triggers for blood component transfusion

PP17

 In general, patients with a platelet count ≥50 × 109/L or an INR ≤2 can undergo invasive procedures without any serious bleeding; however, lower platelet counts and higher INRs may be tolerated.

PP18

 Specialist guidelines or haematology advice should be sought for at-risk patients undergoing intracranial, intraocular and neuraxial procedures, and for patients with severe thrombocytopenia or coagulopathy.

INR, international normalised ratio