The American Society of Clinical Oncology has updated its clinical practice guideline on platelet transfusion for patients with cancer. Among the recommendations after reviewing 3 clinical practice guidelines, 8 systematic reviews, and 13 observational studies:

• The most substantial change involves platelet transfusion in the setting of hematopoietic stem-cell transplantation; adults who undergo autologous stem-cell transplantation at experienced centers may receive a platelet transfusion at the first sign of bleeding, rather than prophylactically.
• Prophylactic platelet transfusion at defined platelet count thresholds is still recommended for pediatric patients undergoing autologous stem-cell transplantation and for adult and pediatric patients undergoing allogeneic stem-cell transplantation.

Additionally, the update addresses platelet transfusion in patients with hematologic malignancies or solid tumors, or in those who undergo invasive procedures. It also provides guidance on producing platelet products, preventing Rh alloimmunization, and managing refractoriness to platelet transfusion.