Anesthesia and platelet disorders

The American Society of Anesthesiologists (ASA) provided the following recommendations:• Prophylactic platelet transfusion is ineffective and rarely indicated when thrombocytopenia is due to increased platelet destruction (e.g. ITP).• Prophylactic platelet transfusion is rarely indicated in surgical patients with thrombocytopenia due to decreased platelet production when the platelet count is greater than 100 x 109/liter and is usually indicated when the platelet count is below 50 x 109/liter. The determination of whether patients with intermediate platelet counts (50 to 100 x 109/liter) require therapy should be based on the patient’s risk of bleeding.• Surgical and obstetric patients with microvascular bleeding usually require platelet transfusion if the platelet count is less than 50 x 109/liter and rarely require therapy if it is greater than 100 x 109/liter. With intermediate platelet counts (50 to 100 x 109/liter), the determination should be based on the patient’s risk for more significant bleeding.• Vaginal deliveries or operative procedures ordinarily associated with insignificant blood loss may be undertaken in patients with platelet counts less than 50 x 109/liter.• Platelet transfusion may be indicated despite an apparently adequate platelet count if there is known platelet dysfunction and microvascular bleeding.