Platelet Transfusion Raises Mortality Risk in Consumptive Thrombocytopenia, with Manas Pustake, MD

Platelet transfusion led to fewer thrombotic events but was associated with higher mortality in patients with consumptive thrombocytopenias, likely due to confounding by indication, based on a retrospective cohort study.1

These data were presented at the 67th American Society of Hematology (ASH) Annual Meeting and Exposition by Manas Pustake, MD, a resident in internal medicine at Texas Tech University. The study specifically examined immune thrombocytopenia (ITP), thrombotic thrombocytopenia purpura (TTP), and heparin-induced thrombocytopenia (HIT). Platelet transfusion is still controversial in these conditions, largely due to concerns that exogenous platelets may cause microthrombosis or worsen the underlying condition.1

“Platelet transfusion has been very controversial in platelet-consumptive disorders like heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura, or disseminated intravascular coagulation,” Pustake told HCPLive in an interview. “So, to answer our research question, we did the study with a National Inpatient Sample dataset to see how platelet transfusion affects thrombosis risk or in-hospital mortality risk.”

Previous studies have highlighted the efficacy of restrictive platelet transfusion strategies, as they have been shown to cause limited increases in mortality or bleeding relative to more liberal strategies. These recommendations reflect guidelines: for consumptive thrombocytopenia in neonates without major bleeding, platelet transfusion is recommended when platelets are <25x10^3/µL, while patients with consumptive thrombocytopenia due to Dengue without major bleeding should not receive platelet transfusions.2

This retrospective cohort study included all admitted patients ≥18 years from 2018 to 2020 with primary or secondary diagnoses of platelet consumptive disorders - including ITP, TTP, HIT, and other primary thrombocytopenias – identified using validated ICD-10-CM codes. Records were sourced from the Healthcare Cost and Utilization Project all-payer inpatient healthcare database. Primary outcomes for the study included arterial/venous thrombotic events and in-hospital mortality. Key secondary outcomes included length of stay (LOS) and hospital costs.1

Ultimately, Pustake and colleagues examined 41,678 hospitalizations with consumptive thrombocytopenia, of which 71.8% were ITP, 16.3% were HIT, 9.5% were TTP, and 2.8% were classified as “other.” Of these, 11.3% received platelet transfusion – this cohort had substantially higher baseline acuity (ventilation: 12% vs 8.7%, shock: 11.8% vs 9.4%, hematologic malignancy: 10.3% vs 6.5%; all P <.001).1

Platelet transfusion was associated with lower adjusted odds of thrombosis (aOR, 0.764; P <.001). Shock (aOR, 1.546; P <.001) and HIT (aOR, 3.21; P <.001) increased thrombosis risk, as well as being on mechanical ventilation (aOR, 1.593; P <.001). Higher in-hospital mortality was also linked to platelet transfusion (aOR, 1.411; P <.001). Mortality was high with TTP (aOR, 2.422; P = .005), sepsis (aOR, 1.843; P <.001), shock (aOR, 3.307; P <.001), and mechanical ventilation (aOR, 8.643; P <.001).1

Regarding secondary outcomes, platelet transfusion was associated with longer mean LOS (10.04 vs 8.18 days; P <.001) and higher mean costs ($179,597 vs $120,825; P <.001). Thrombotic events substantially increased LOS (11.92 vs 7.53 days; P <.001). Additionally, platelet transfusion’s association with reduced thrombosis persisted when stratified by the presence or absence of hematologic malignancy (no malignancy: aOR, 0.777; P <.001; malignancy: aOR, 0.603; P = .002).1

Pustake and colleagues attribute the higher mortality rates noted during the study to confounding by indication, such as sicker patients receiving transfusions. The team determined that these findings confirm established guideline recommendations to avoid platelet transfusion in high-thrombosis-risk conditions such as TTP and HIT.1

“Platelets are transfused to patients having significant bleeding, so the key takeaway from this study is that platelet transfusion should be more conservative and restrictive,” Pustake said. “But that judgement should be made by the clinician.”

References

1. Pustake M, Kattamuri L, Sharma K, Deoker A. Platelet transfusion is associated with reduced thrombosis yet elevated mortality in consumptive thrombocytopenias: A retrospective cohort study. Abstract presented at the 67th American Society of Hematology Annual Meeting. Orlando, FL. December 6-9, 2025.

2. Metcalf RA, Nahirniak S, Guyatt G, et al. Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA. 2025;334(7):606-617. doi:10.1001/jama.2025.7529