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

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Abstract  

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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Authors and Affiliations

  1. Department of Internal Medicine, University of Maryland Medical Center, Baltimore, MD, USA

    Roxana Amirahmadi

  2. Department of Critical Care Medicine, William Beaumont Army Medical Center, El Paso, TX, USA

    Scott Sullivan

  3. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Noel Britton

  4. Department of Internal Medicine, New York University Langone Health, New York, NY, USA

    Ariel Siegel

  5. Departments of Critical Care and Emergency Medicine, Washington Hospital Center, Washington, DC, USA

    Rory Spiegel

  6. University of Maryland Medical Center, Baltimore, MD, USA

    Jennifer Miceli & Jeffrey T. Sholander

  7. University of Maryland School of Medicine, Baltimore, MD, USA

    Vu Duong, Magali J. Fontaine & Michael T. McCurdy

Authors
  1. Roxana Amirahmadi
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  2. Scott Sullivan
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  3. Noel Britton
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  4. Ariel Siegel
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  6. Jennifer Miceli
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  7. Vu Duong
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Corresponding author

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). https://doi.org/10.1007/s00277-022-04891-y

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  • DOI: https://doi.org/10.1007/s00277-022-04891-y

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