Patient Blood Management for Platelet Transfusion: Current Evidence, Safety Concerns and Practical Implementation in Hematology

Platelet transfusion is essential in hematology but remains characterized by practice variability, uneven certainty of evidence across clinical settings, short component shelf life and clinically relevant adverse effects. This narrative review integrates evidence on efficacy, thresholds and dosing, safety, and implementation of platelet-specific patient blood management (PBM). In stable non-bleeding therapy-induced thrombocytopenia, a restrictive prophylactic threshold of 10 × 10⁹/L is supported by randomized evidence and contemporary guidelines, whereas higher thresholds increase exposure without consistent clinical benefit. Therapeutic-only strategies reduce utilization but are not equally safe across populations, particularly in acute leukemia. Platelet PBM should therefore combine indication-specific protocols, a single-adult-dose policy with reassessment, audit and feedback, post-transfusion response monitoring, refractoriness management, inventory stewardship and multidisciplinary governance. The objective is not simply fewer transfusions, but fewer unnecessary transfusions with preserved hemostatic safety.