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Platelet Transfusion in Critical Care and Surgery: Evidence-Based Review of Contemporary Practice and Future Directions

Etchill, Eric W.; Myers, Sara P.; Raval, Jay S.; Hassoune, Adnan; SenGupta, Anirban; Neal, Matthew D.

doi: 10.1097/SHK.0000000000000794
Review Articles

ABSTRACT: Thrombocytopenia is prevalent in critical care, surgical, and trauma settings. Despite the fact that a significant proportion of these patients receive platelet transfusion during their hospital course, much work remains to be done with regard to development of platelet transfusion guidelines. Given the wide variety of platelet transfusion practices and the frequency with which patients present with thrombocytopenia, it is paramount to understand standards of care and to identify deficiencies that may exist. This review explores evidence and recommendations for platelet transfusion thresholds and practices in a variety of critical care and surgical settings with specific focus on the role of platelet transfusion in trauma, management and reversal of anticoagulation, and point of care laboratory assays. To this end, a literature review was performed utilizing PubMed and Cochrane Central Register of Controlled Trials to select 153 manuscripts that evaluate the current data supporting platelet transfusions in surgical and critical care populations. Advances in transfusion medicine and synthetic platelet substitutes that can be engineered for potential future applications will also be discussed.

*University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

University of North Carolina School of Medicine, Chapel Hill, North Carolina

American University of Beirut, Beirut, Lebanon

§Case Western Reserve University, Cleveland, Ohio

Address reprint requests to Matthew D. Neal, MD, Assistant Professor of Surgery and Critical Care Medicine, Division of Trauma and Acute Care Surgery, Department of Surgery, F1271.2 PUH 200 Lothrop Street, Pittsburgh, PA 15213; E-mail: nealm2@upmc.edu

Received 28 August, 2016

Revised 12 September, 2016

Accepted 7 November, 2016

Dr MDN and Dr AS provided assistance with acquisition and appraisal of available literature as well as drafting and critical review of the manuscript. Drs EWE and SPM were primarily responsible for literature review and drafting of the manuscript as co-authors. Dr JSR contributed to organization of this review and drafting of the manuscript. AH contributed to acquisition and critical review of data and existing literature.

The work for this review was conducted at the University of Pittsburgh School of Medicine.

Drs EWE and SPM contributed equally to this work.

The authors report no conflicts of interest.

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