Practical advice on the appropriate use of platelets

The Association for the Advancement of Blood & Biotherapies (AABB) in partnership with the International Collaboration for Transfusion Medicine Guidelines (ICTMG) have published a new set of platelet transfusion guidelines, with practical advice on the appropriate use of platelets in various clinical settings. 

The guidelines are informed by a recent systematic literature review and meta-analysis. Data from 21 randomised controlled trials (RCTs) and 13 observational studies were examined to compare transfusion strategies using fewer (restrictive) vs greater (liberal) amounts of platelets. The specific definitions of restrictive and liberal varied between trials, with most using platelet count thresholds. Different platelet doses or varying timing of platelet transfusion were used less commonly.

The panel concluded that the ‘evidence demonstrated that restrictive transfusion strategies probably did not cause increases in mortality or bleeding relative to liberal strategies across predefined clinical populations’.

The guidelines offer recommendations for platelet transfusion based on specific patient criteria and vary depending on patients’ needs, categorised based on the degree of evidence.

Changes to sexual activity rules for blood and plasma donation

Australians will be able to donate blood and plasma following important changes to sexual activity eligibility rules.

Current donor rules in Australia prevent many gay and bisexual men and transgender women who have sex with men from giving blood or plasma if they have had sex in the past three months.

Lifeblood has been working to make blood and plasma donation more inclusive and accessible to as many people as possible, whilst maintaining the safety of the blood supply.

In the first of the rule changes, from Monday 14 July 2025 Lifeblood will remove most sexual activity wait times for plasma donations.

Updated direct oral coagulants (DOACs) guidelines

The 2025 Guidelines for direct oral anticoagulants (DOACs) provides Australian clinicians and health services with practical guidance on prescription, laboratory testing, peri-operative and bleeding management including use of reversal agents. They are endorsed by the Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ).

Use of DOACs has become widespread and when major bleeding episodes occur, there is a critical need for safe and effective management strategies. 

The guidelines provide an algorithm for management of DOAC-related bleeding, encompassing the spectrum of mild, clinically significant and life-threatening (bleeding in critical area or organ e.g. intraocular, intracranial, intraspinal, compartment syndrome, retroperitoneal or pericardial, hypotension not responding to resuscitation).

In life-threatening bleeding, the anticoagulant effects of DOACs can be reversed with drug-specific agents where available. If unavailable, pro-haemostatic agents such as prothrombin complex concentrates (PCCs) or activated PCCs can be considered. Where PCCs (Beriplex in Australia) are used for reversal of factor Xa inhibitors, the dosing guidance provided within the algorithm for critical bleeding is 25 – 50 IU/kg, or alternatively a fixed dose of 2000 IU.

These 2025 THANZ endorsed DOAC guidelines provide an essential tool to support clinical practice and a key resource to update local health service procedures.

'How I Treat' series on transfusion medicine

Stay up to date with the case-based 'How I Treat' series from the journal Blood where experts provide updates and practical guidance which includes:

• How I treat challenging transfusion cases in sickle cell disease
• How I manage pregnant patients who are alloimmunized to RBC antigen
• How I manage major hemorrhage
• How I diagnose and treat cardiorespiratory complications of transfusion
• How I use noninvasive prenatal testing for red blood cell and platelet antigens
• How I treat patients who are refractory to platelet transfusions

How do we leverage implementation science?

Many of us in the transfusion community are, have or will be, involved in acknowledging a new clinical guideline and assisting with its implementation into practice. Did you know that on average it takes 17 years for evidence to diffuse into practice?

Surely there's a better way?

Crawshaw et al.'s recent publication in Transfusion: ‘How do we leverage implementation science to support and accelerate uptake of clinical practice guidelines in transfusion medicine’ provides an insightful and considered approach drawing upon the approaches and frameworks from knowledge translation and implementation sciences.

Blood management committees (BMCs) are often tasked with planning and disseminating new knowledge, often spending hours analysing and brainstorming ways to close practice gaps. The article provides a 5-step road map that BCMs can use to unify the group in its approach to understanding the implications of new guideline implementation.

Specifically, the approach leads the BCM to identify:

• who and what needs to be done differently
• what in your organisation may help or inhibit this new behaviour change, and
• how best to impart this new knowledge and behaviour change in your organisation in a manner that can be measured and sustained.

Do you know how to manage critical bleeding?

Our BloodSafe eLearning colleagues are excited to announce the launch of their fourth critical bleeding course, Managing Critical Bleeding.

This interactive, case-based module is part of a suite of six courses designed to provide practical guidance on managing critical bleeding scenarios.  

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