# Platelet transfusion thresholds for children with cancer

Source: https://onco.cc/protocols/paediatric-platelet-transfusion-thresholds/  
OnCo record `paediatric-platelet-transfusion-thresholds` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Chemotherapy can lower platelets, the blood cells that stop bleeding. A child who is not bleeding is usually given a platelet transfusion only when the count falls below 10, because giving them earlier does not prevent more bleeding. Higher counts are needed before a lumbar puncture or surgery, and for a child who is bleeding.

## Summary

The 2025 AABB and ICTMG international guidelines (GRADE, 21 randomised trials and 13 observational studies), endorsed by the Children's Oncology Group in February 2026, favour restrictive platelet use. For non-bleeding patients with hypoproliferative thrombocytopenia receiving chemotherapy or undergoing allogeneic stem cell transplant, transfuse at a platelet count below 10 × 10³/μL (strong, moderate). Before lumbar puncture, transfuse below 20 × 10³/μL (strong, moderate), recognising an extremely low rate of spinal haematoma. Preterm neonates without major bleeding are transfused below 25 × 10³/μL (strong, high). A good practice statement asks clinicians to weigh symptoms, bleeding history, medicines, values and the whole clinical picture. NICE NG24 (children over 1 year, extrapolated from adults) agrees on prophylaxis below 10 × 10⁹/L, gives a threshold of 30 × 10⁹/L for clinically significant (WHO grade 2) bleeding and up to 100 for severe or critical-site bleeding, considers raising the count above 50 for invasive procedures or surgery, and advises no prophylactic platelets for bone marrow aspiration and trephine. One dose at a time, then reassess the child and recheck the count.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: paediatric platelet transfusion; prophylactic platelet transfusion children; platelet threshold lumbar puncture; platelet count 10 transfusion
- Tags: protocol; paediatric; transfusion

## Connected records

- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Acute myeloid leukaemia](https://onco.cc/cancers/aml/), [Childhood cancers (all types)](https://onco.cc/cancers/childhood-cancers/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Allogeneic stem cell transplantation](https://onco.cc/technologies/allogeneic-hsct/), [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/)
- companies: [Children's Oncology Group (COG)](https://onco.cc/companies/childrens-oncology-group/)
- institutions: [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Intrathecal therapy (lumbar puncture, Ommaya reservoir)](https://onco.cc/terms/intrathecal-therapy/), [Thrombocytopenia](https://onco.cc/terms/thrombocytopenia/)

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