American Society of Hematology-American Society of Pediatric Hematology/Oncology

View all recommendations from this society

Released December 9, 2019; Updated July 28, 2021

Don’t transfuse platelets in an asymptomatic (i.e., non-bleeding) pediatric patient with hypoproliferative thrombocytopenia (e.g. aplastic anemia, leukemia, etc.), with a platelet count > 10,000/mcL who is at least one year old, unless signs and/or symptoms for bleeding develop, or if the patient is to undergo an invasive procedure.

In asymptomatic (i.e, non-bleeding) pediatric patients with hypoproductive thrombocytopenia conditions such as bone marrow failure or malignancy with a platelet count > 10,000/mcL, transfusion is not clinically indicated unless signs, symptoms, or increased risk factors of bleeding are present. This practice is consistent with recommendations from the clinical guidelines of multiple associations (National Institute for Health and Care Excellence, British Society for Haematology, American Society of Clinical Oncology, and American Society of Hematology). The risk of spontaneous bleeding is low at platelet counts > 10,000/mcL. Unnecessary transfusions put patients at risk for transfusion reactions, alloimmunization, blood borne infections, and refractoriness to future platelet transfusions. This recommendation does not apply in anticipation of an invasive procedure.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Society of Hematology (ASH) and the American Society of Pediatric Hematology/Oncology (ASPHO) formed a task force to solicit, evaluate, and select list items for a pediatric focused Choosing Wisely list.  The panel was composed of 13 members – two co-chairs (representing ASH and ASPHO), five members selected by each organization, and one member serving as an advisor on Choosing Wisely methodology.  Suggestions were solicited from the membership of both societies.  Formal systematic reviews of the evidence were completed for eight semi-finalist items.  Final item selections were made by the ASH-ASPHO CW task force with reference to the following six guiding principles: avoiding harm to patients, producing evidence-based recommendations, considering both the cost and frequency of tests and treatments, making recommendations in the clinical purview of the hematologist, and considering the potential impact of recommendations. Harm avoidance was established as the campaign’s preeminent guiding principle.


National Institute for Health and Care Excellence. Blood transfusion NICE Guideline 24. 2015 Nov; Retrieved from

Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011 Apr;117(16):4190–4207.

New HV, Berryman J, Bolton-Maggs PH, Cantwell C, Chalmers EA, Davies T, Gottstein R, Kelleher A, Kumar S, Morley SL, Stanworth SJ. Guidelines on transfusion for fetuses, neonates and older children. British Journal of Haematology. 2016 Nov;175(5):784-828.

Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, Omel JL, Rainey JM, Rebulla P, Rowley SD, Troner MB, Anderson KC. Platelet Transfusion for Patients With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology. 2018 Jan;36(3):283-299.