Preoperative platelet transfusions and perioperative red blood cell requirements in patients with thrombocytopenia undergoing noncardiac surgery.

Matthew A. Warner, Qing Jia, Leanne Clifford, Gregory Wilson, Michael J. Brown,
Andrew C. Hanson, Darrell R. Schroeder, and Daryl J. Kor
TRANSFUSION 2016;56;682–690

RBC transfusion is associated with multiple adverse outcomes, and is best avoided if possible. Platelet (PLT) transfusions are sometimes administered pre-operatively in an attempt to decrease surgical blood loss. Often, the cutoff value that triggers the decision to transfuse PLT is ≤ 100 X 109 /L. These investigators performed a retrospective cohort study in patients with preoperative PLT counts of ≤ 100 X 109 /L who were undergoing noncardiac surgery, and compared patients who received preoperative PLT transfusion with patients who did not receive preoperative PLT transfusion. The primary outcome variable was RBC transfusion intraoperatively or within 24 hours of discharge from the OR environment.

13,978 Patients met inclusion criteria. Of these, 860 (6.2%) had a PLT count ≤ 100 X 109 /L. Of these, 71 (8.3%) received a preop PLT transfusion, while 789 (91.7%) did not. Patients who had a preop PLT transfusion received more perioperative RBC transfusions (p = 0.0065); were more often admitted to the ICU (p < 0.0001); had longer hospital LOS (p < 0.0001); and greater mortality (p < 0.0001).

Compared with patients with PLT count > 100 X 109 /L, patients with PLT count ≤ 100 X 109 /L had higher rates of periop RBC transfusion (50.2% vs. 18.4%; p < 0.0001) and reoperation for bleeding (8.1% vs. 2.1%; p < 0.0001). Preop thrombocytopenia was also associated with increased all-cause mortality after adjustment for between-group differences (OR [95% CI], 1.87 [1.29-2.70]; p = 0.0009).

Propensity adjusted analyses found no evidence of improved outcomes when patients with preop thrombocytopenia received preop PLT transfusion. It may be that providers who are likely to transfuse PLT preop are also likely to transfuse RBC intraop. It may also be that PLT transfusion is not an effective method to decrease bleeding in the population studied. It should be noted that a specific post-transfusion PLT count was not required for inclusion in the analysis.

In summary, PLT count ≤ 100 X 109 /L was associated with increased transfusion of perioperative RBC, but PLT transfusion did not improve outcomes.

Sheldon Goldstein, MD

Attending Anesthesiologist, Montefiore Medical Center

Clinical Associate Professor of Anesthesiology, Albert Einstein College of Medicine