Analyses of randomized controlled trials of patients with hypoproliferative thrombocytopenia (such as those receiving chemotherapy or undergoing allogenic stem cell transplant) show that restrictive platelet transfusion strategies do not significantly increase risks of bleeding or mortality. Specifically, there were no meaningful differences in WHO grade 2–4 bleeding, WHO grade 3–4 bleeding, or mortality with absolute risk differences remaining small and confidence intervals overlapping. There is no need to increase the threshold above 10 x 109/L except if there is active bleeding, an imminent invasive procedure, or there is a recent intracranial/intraocular/spinal hemorrhage.
Sources:
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Metcalf RA, et al. Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA. 2025 Aug 19;334(7):606-617. PMID: 40440268.