E Editorial
Are We Begging a Question or Begging an Answer? Aryeh Shander, MD,*† and Terry Gernsheimer, MD‡
T
imely identification of patients in whom the potential benefits of transfusions outweigh the risks remains hotly debated.1 Despite their ubiquitous clinical use, many red blood cell (RBC) transfusion decisions are still based on arbitrary hemoglobin triggers.2 The case of prophylactic platelet transfusion is even more enigmatic, given that clinicians must consider not only platelet number (count) but also the functional status of platelets, not yet commonly measured in the clinical arena and the state of the endothelium, still an evolving field. Platelets are one of many contributors to the complex hemostatic system, and the platelet count and function needed to control bleeding in any clinical situation remains unclear. Severe thrombocytopenia predisposes to spontaneous bleeding and possibly an increased size of the bleed (both prominent concerns in the central nervous system [CNS]). Thrombocytopenia may also increase the risk of bleeding and adverse outcomes in adults and pediatric patients undergoing invasive procedures.3 Recommendations for platelet transfusion typically use a threshold platelet count number as a cutoff for transfusion.4,5 Commonly used thresholds include: platelet count
Are We Begging a Question or Begging an Answer? Aryeh Shander, MD,*† and Terry Gernsheimer, MD‡
T
imely identification of patients in whom the potential benefits of transfusions outweigh the risks remains hotly debated.1 Despite their ubiquitous clinical use, many red blood cell (RBC) transfusion decisions are still based on arbitrary hemoglobin triggers.2 The case of prophylactic platelet transfusion is even more enigmatic, given that clinicians must consider not only platelet number (count) but also the functional status of platelets, not yet commonly measured in the clinical arena and the state of the endothelium, still an evolving field. Platelets are one of many contributors to the complex hemostatic system, and the platelet count and function needed to control bleeding in any clinical situation remains unclear. Severe thrombocytopenia predisposes to spontaneous bleeding and possibly an increased size of the bleed (both prominent concerns in the central nervous system [CNS]). Thrombocytopenia may also increase the risk of bleeding and adverse outcomes in adults and pediatric patients undergoing invasive procedures.3 Recommendations for platelet transfusion typically use a threshold platelet count number as a cutoff for transfusion.4,5 Commonly used thresholds include: platelet count
