关键词: 血小板输注指南, 限制性输注策略, GRADE系统, 输注阈值, 输血反应

Abstract: In May 2025, the Association for the Advancement of Blood and Biotherapies (AABB) and the International Collaboration for Transfusion Medicine Guidelines (ICTMG) jointly released the updated Guidelines for Platelet Transfusion. Based on 21 Randomized Clinical Trials (RCTs) and 13 high-quality observational studies, the guideline adopted the Grading of Recommendations Assessment Development and Evaluation (GRADE) system for evidence analysis, and established the "restrictive platelet transfusion strategy" as the core, aiming to promote the standardization and homogenization of global platelet transfusion practices. The guideline has a wide scope of application, covering different populations such as adults, children, and neonates, including patients with hematological diseases, stem cell transplant recipients, perioperative patients, dengue fever patients, and those undergoing invasive procedures. It sets minimal important differences (MIDs) thresholds for three key outcomes—mortality (2%), grade 2-4 bleeding (20%), and grade 3-4 bleeding (5%)—for evidence certainty grading. In terms of key recommendations, it clarifies strong recommendations with high/moderate certainty of evidence (e.g., transfusion for patients with non-bleeding thrombocytopenia undergoing chemotherapy or allogeneic stem cell transplantation when platelet count<10×10⁹/L; transfusion for neonates with consumptive thrombocytopenia without severe bleeding when count<25×10⁹/L; no transfusion for dengue fever patients without major bleeding, etc.) and conditional recommendations with low/very low certainty of evidence (e.g., conditional non-recommendation of prophylactic transfusion for adult patients undergoing autologous stem cell transplantation; conditional transfusion for adult patients undergoing central venous catheterization when count<10×10⁹/L, etc.). Meanwhile, it elaborates on common platelet transfusion reactions and their risks, such as allergic reactions, febrile reactions, and transfusion-related acute lung injury (TRALI). By lowering transfusion thresholds and refining risk stratification, the guideline can reduce unnecessary transfusions and related adverse reactions, and alleviate the shortage of platelet resources. In the future, it is necessary to further supplement evidence-based evidence in fields such as cardiopulmonary bypass and interventional radiology, and explore technologies like in vitro induced differentiation of platelets and universal engineered platelets to optimize transfusion practices.

Key words: Platelet transfusion guidelines, Restrictive transfusion strategy, GRADE system, Transfusion threshold, Transfusion reactions