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The right transfusion, always, everywhere.
International clinical practice guidelines on the use of platelet transfusion in multiple clinical settings
Access the open-access systematic review and meta-analysis preformed by ICTMG at:
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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.
Access the international guideline developed by ICTMG in partnership with AABB, offering practical guidance 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.
Resources and tools for health care professionals
The 2025 ICTMG/AABB platelet transfusion guideline represents a major advancement in transfusion medicine, providing a framework for safer, more sustainable transfusion practice through evidence-based, restrictive platelet transfusion strategies.
The guideline offers practical recommendations across a range of clinical settings and aims to improve consistency in clinical decision-making, reduce transfusion-related risks, optimize platelet utilization, and support quality improvement initiatives.
The resources below are designed to support dissemination and implementation of the guideline. Healthcare professionals are encouraged to use these materials for self-directed learning and to adapt them for local presentations, educational sessions, and professional development activities, and quality improvement initiatives.
Educational presentations
Editable slide deck
Editable PowerPoint slides summarizing the guideline's key recommendations, evidence, and clinical implications. The slides may be customized for local presentations, educational sessions, and implementation activities.
Download the slide deck by clicking the PPT icon.
Recorded didactic lecture (University of Toronto Transfusion Medicine Rounds)
View a one-hour presentation by guideline authors Dr. Ryan Metcalf and Dr. Susan Nahirniak discussing the evidence, recommendations, and clinical implications of the guideline. The recording is hosted by ORBCoN.
Access the recording by clicking the video icon.
Case studies
Intracranial Hemorrhage (ICH) case study
Explore the application of the guideline recommendation #2.7 in the management of a patient with intracranial hemorrhage.
Access the interactive case study. Download a printable version of the case study.
Access the interactive case study. Download a printable version of the case study.
Allogenic stem cell transplant case study
Explore the application of the guideline recommendation #1.1 in the management of a patient undergoing an allogeneic stem cell transplant.
Additional case studies in development
Additional clinical scenarios are currently being developed to support application of the guideline recommendations across a broader range of practice settings.
Expert discussions
Breakthroughs in blood: Advancements into action (Canadian Blood Services)
Listen to guideline author Dr. Ryan Metcalf and Panel members Drs. Katerina Pavenski, Neill Adhikari, Susan Nahirniak describe and discuss the risks, benefits and evidence supporting restrictive platelet transfusion strategies. Hosted by Dr. Jeannie Callum, this series delves into the "So what?" and "Now what?" of blood science and medical research, with a dedicated focus on transfusion clinical trials and guidelines.
Access the video by clicking the video icon.
Podcast interview (JAMA)
Listen to guideline author Dr. Ryan Metcalf discuss the key recommendations and clinical implications of the guideline, including restrictive versus liberal platelet transfusion strategies, in conversation with JAMA Executive Editor Dr. Gregory Curfman.
Access the podcast by clicking the audio button
Video interview (Let's Talk Patient Blood Management)
Watch Dr. Ryan Metcalf discuss the guideline recommendations and their implications for clinical practice in the video "Guiding Platelet Practice: Inside the AABB/ICTMG Recommendations."
Access the video by clicking the video icon.
Stay informed
Additional educational and implementation resources are currently in development. Sign up to receive notification when new materials are added to this page.
Endorsements
The guideline has received endorsement from leading professional organizations, reflecting its relevance and applicability across international healthcare settings.
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The Canadian Hematology Society endorsed the guideline in November 2025.
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The European Society of Anaesthesiology and Intensive Care (ESAIC) endorsed the guideline in June 2025
Why did ICTMG develop a guideline for platelet transfusion?
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.
Read a short blog post describing key takeaways from the guideline and the importance of platelet transfusion guidelines in ICTMG partners with AABB to advance platelet transfusion practice with publication of new international guidelines on Canadian Blood Services' Research.Education.Discovery (R.E.D.) blog.
