Why did ICTMG develop a guideline for platelet transfusion?

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​Platelet transfusions are commonly used to manage and reduce the risk of bleeding in patients with thrombocytopenia. Similar to other blood components, their use is associated with adverse events, but their short shelf storage life also leads to frequent shortages and higher costs.

Guidelines are an important tool to promote appropriate and optimal use of platelets. However, the quality of guidelines varies. In 2021, ICTMG conducted a systematic review that revealed inconsistencies in the quality components of many completed platelet transfusion guidelines. (Al-Riyami AZ, Jug R, La Rocca U, Keshavarz H, Landry D, Shehata N, Stanworth SJ, Nahirniak S. Quality of Evidence-based Guidelines for Platelet Transfusion and Use: A Systematic Review. Transfusion, 2021; 61: 948-958). New trial evidence continues to be published, making updates of guidelines important. Platelet transfusions are also used broadly, in multiple clinical populations, and not just hypoproliferative thrombocytopenia which was the focus of a prior 2015 ICTMG guideline. 

To address these challenges, ICTMG performed a systematic review of platelet transfusion threshold practice across multiple populations. ICTMG collaborated with the Association for the Advancement of Blood and Biotherapies (AABB) to develop an international guideline. The guideline included many experts in platelet transfusion medicine around the world, representing different clinical settings as well as patient representatives. This guideline offers practical advice on platelet transfusions, balancing restrictive and liberal approaches in various clinical settings. 

It is hoped this new guideline will improve consistency, reduce risks, and optimize the use of platelet transfusions in patient care, and provide a framework for quality improvement initiatives in hospitals. They represent a major advancement in transfusion medicine, providing a framework for safer, more sustainable transfusion practice by promoting a shift toward restrictive platelet transfusion strategies.

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How to access the ICTMG publications

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The ICTMG performed a systematic review and meta-analysis:

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• Jug R, La Rocca U, Al-Riyami AZ, Bathla A, Metcalf RA, White SK, Stanworth SJ, Nahirniak S. The clinical use of platelet transfusions: A systematic literature review and meta-analysis on behalf of the International Collaboration for Transfusion Medicine Guidelines. Transfusion. 2025.

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The ICTMG and AABB developed an international guideline to offer practical advice on platelet transfusions, balancing restrictive and liberal approaches in various clinical settings.

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• Metcalf RA, Nahirniak S, Guyatt G, Bathla A, White SK, Al-Riyami AZ, Jug RC, La Rocca U, Callum JL, Cohn CS, DeAnda A, DeSimone RA, Dubon A, Estcourt LJ, Filipescu DC, Fung MK, Goel R, Hess AS, Hume HA, Kaufman RM, Kranke P, Louw VJ, Møller MH, Murphy MF, Muszynski JA, O'Kelly CJ, Pagano MB, Patidar GK, Pavenski K, Poston JN, Saifee NH, Stolla M, Szczepiorkowski ZM, Tobian AAR, Uberoi R, Waters J, Williams B, Wood EM, Zantek ND, Zeller MP, Grossman BJ, Stanworth SJ.  Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA. Published online May 29, 2025.
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