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Pre-Procedure Platelet Transfusion — RACP Adult Medicine MCQ

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ModerateHaematologyPre-Procedure Platelet TransfusionRACP Adult Medicine

A 55-year-old man with cirrhosis is undergoing a liver biopsy. His INR is 2.5 and fibrinogen is 1.0 g/L. Platelet count is 45 × 10⁹/L. He has no active bleeding. What is the most appropriate pre-procedure transfusion product?

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Correct answer: D — Platelets

For invasive procedures in patients with thrombocytopenia, platelet transfusion is indicated to maintain platelets >50 × 10⁹/L (or >100 × 10⁹/L for neurosurgery/ophthalmic surgery). FFP to correct INR in cirrhosis is controversial — cirrhotic coagulopathy is rebalanced (both pro- and anti-coagulant factors are reduced). Viscoelastic testing (ROTEM/TEG) may better guide transfusion in cirrhosis.

Reference: NBA – 2024 – Patient Blood Management Guidelines; GESA 2024