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Lowering platelet count threshold to 10,000/µL for peripherally inserted central catheter placement safely conserves blood products


Despite the low risk of peripherally inserted central catheter (PICC) insertion-related bleeding, the practice of administering prophylactic platelets varies greatly. Limiting unnecessary blood product transfusions reduces transfusion-related adverse events, financial cost, and delays in care. We assessed the impact of lowering prophylactic platelet administration threshold on blood product utilization patterns and bleeding events. This quasi-experimental study was conducted in an urban academic tertiary medical center. The study population included patients with platelet counts ≥ 10,000/µL and < 50,000/µL undergoing PICC placement in 2018 and 2019 when the minimum platelet thresholds were 50,000/µL and 10,000/µL, respectively. The primary outcome was blood product utilization and the secondary outcome was PICC insertion-related bleeding complications. Thirty-five patients using the 10,000/µL (10 K) platelet threshold and 46 patients using the 50,000/µL (50 K) platelet threshold were enrolled. The 50 K group received more platelets before PICC insertion (0.870 ± 0.885 and 0.143 ± 0.430 pools of platelets-per-person, p < 0.001). No patients experienced clinically significant bleeding. Immediately following PICC insertion, minor bleeding occurred in five patients (two [4.3%] and three [8.6%] in the 50 K and 10 K groups, respectively). Bleeding rates between the two cohorts did not differ (p = 0.647). Lowering the minimum platelet threshold from 50,000/µL to 10,000/µL resulted in less prophylactic platelet and total blood product administration with no appreciable difference in PICC insertion-related bleeding.

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  1. Kaufman RM, Djulbegovic B, Gernsheimer T et al (2015) Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 162(3):205–213.

    Article  PubMed  Google Scholar 

  2. Schiffer CA, Bohlke K, Delaney M et al (2018) Platelet transfusion for patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol 36(3):283–299.

    Article  PubMed  Google Scholar 

  3. Patel IJ, Rahim S, Davidson JC et al (2019) Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations: Endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol 30(8):1168-1184.e1.

    Article  PubMed  Google Scholar 

  4. Cavanna L, Citterio C, Nunzio Camilla D, Orlandi E, Toscani I, Ambroggi M (2020) Central venous catheterization in cancer patients with severe thrombocytopenia: ultrasound-guide improves safety avoiding prophylactic platelet transfusion. Mol Clin Oncol 12(5):435–439.

    Article  PubMed  PubMed Central  Google Scholar 

  5. AlRstum ZA, Huynh TT, Huang SY, Pisimisis GT (2019) Risk of bleeding after ultrasound-guided jugular central venous catheter insertion in severely thrombocytopenic oncologic patients. Am J Surg 217(1):133–137.

    Article  PubMed  Google Scholar 

  6. Kiefel V (2008) Reactions induced by platelet transfusions. Transfus Med Hemotherapy 35(5):354–358.

    Article  Google Scholar 

  7. Davidson JC, Rahim S, Hanks SE et al (2019) Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations. J Vasc Interv Radiol 30(8):1155–1167.

    Article  PubMed  Google Scholar 

  8. Steinke K, Liu H (2014) Minimally invasive techniques for medically inoperable stage I non-small cell lung cancer (NSCLC)–image-guided microwave ablation, a promising therapy option. J Med Imaging Radiat Oncol 58(1):79–80.

    Article  PubMed  Google Scholar 

  9. Vascular Access Devices Market Analysis, Size, Trends | United States | 2020–2026 | COVID19 | MedSuite. iData Research. Accessed November 22, 2020.

  10. Cost of Blood Components. Accessed November 22, 2020.

  11. Zeidler K, Arn K, Senn O, Schanz U, Stussi G (2011) Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia. Transfusion (Paris) 51(11):2269–2276.

    Article  Google Scholar 

  12. Potet J, Arnaud F-X, Thome A et al (2015) Peripherally inserted central catheter placement in patients with coagulation disorders: a retrospective analysis. Diagn Interv Imaging 96(11):1147–1151.

    CAS  Article  PubMed  Google Scholar 

  13. Warner MA, Woodrum D, Hanson A, Schroeder DR, Wilson G, Kor DJ (2017) Preprocedural platelet transfusion for patients with thrombocytopenia undergoing interventional radiology procedures is not associated with reduced bleeding complications. Transfusion (Paris) 57(4):890–898.

    Article  Google Scholar 

  14. Estcourt LJ, Desborough M, Hopewell S, Doree C, Stanworth SJ (2015) Comparison of different platelet transfusion thresholds prior to insertion of central lines in patients with thrombocytopenia. Cochrane Database Syst Rev 12:CD011771.

    Article  Google Scholar 

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Correspondence to Roxana Amirahmadi.

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Amirahmadi, R., Sullivan, S., Britton, N. et al. Lowering platelet count threshold to 10,000/µL for peripherally inserted central catheter placement safely conserves blood products. Ann Hematol 101, 2045–2052 (2022).

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  • Thrombocytopenia
  • Blood-products
  • Bleeding
  • Central venous access
  • Procedure complications