# Red cell and platelet transfusion thresholds in cancer care

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

## TL;DR

During cancer treatment your red cells or platelets may fall. Blood or platelet transfusions are given when the levels fall below set points, or when you are bleeding, rather than to bring the numbers back to normal. Giving less blood at higher thresholds has proved just as safe in trials, and spares people the risks of transfusion.

## Summary

For red cells, NICE NG24 recommends a restrictive threshold for people without major haemorrhage, acute coronary syndrome or regular transfusion for chronic anaemia: consider transfusing at haemoglobin 70 g/L, aiming for 70 to 90 g/L afterwards, with a threshold of 80 g/L and target 80 to 100 g/L in acute coronary syndrome. AABB (2023) suggests the same 7 g/dL threshold for hospitalised adults with haematological and oncological disorders (conditional, low certainty), within its strong recommendation for stable hospitalised adults generally; clinicians may use 8 g/dL with pre-existing cardiovascular disease. Give single units to adults who are not bleeding, and reassess after each.

For platelets, prophylactic transfusion is given below 10 × 10⁹/L in people not bleeding and not having procedures (NICE; AABB/ICTMG 2025 strong recommendation for chemotherapy and allogeneic transplant), with no routine prophylaxis in chronic bone marrow failure, immune thrombocytopenia, heparin-induced thrombocytopenia or TTP. Adults having autologous transplant may be transfused at the first sign of bleeding rather than prophylactically (ASCO 2018; AABB/ICTMG 2025 conditional). For bleeding, NICE offers platelets for WHO grade 2 bleeding below 30 × 10⁹/L and allows up to 100 × 10⁹/L for severe or critical-site bleeding. Before procedures, NICE considers raising the count above 50 × 10⁹/L (100 × 10⁹/L for the central nervous system or back of the eye), while AABB/ICTMG (2025) set lower thresholds for some, such as 10 × 10⁹/L for central venous catheters in compressible sites and 20 × 10⁹/L for lumbar puncture. Give a single dose and recheck.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: restrictive transfusion threshold; when to transfuse in cancer; platelet transfusion threshold during chemotherapy; blood transfusion for anaemia in cancer; prophylactic platelet transfusion
- Tags: protocol; transfusion; supportive-care

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Transfusion support and anaemia management](https://onco.cc/technologies/transfusion-support/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/), [National Institute for Health and Care Excellence](https://onco.cc/institutions/nice/)
- terms: [Anaemia](https://onco.cc/terms/anaemia/), [Thrombocytopenia](https://onco.cc/terms/thrombocytopenia/)
- protocols: [Anaemia during chemotherapy: investigation, iron and erythropoiesis-stimulating agents](https://onco.cc/protocols/chemotherapy-induced-anaemia-esa-and-iron/)

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