Platelets are critical for clot formation. A normal platelet count is 250 × 103 cells/µl of blood, and there are approximately 2 × 1012 platelets in the whole body, with two thirds in circulation and one third sequestered in the spleen. Platelets provide both primary hemostasis through the formation of a platelet plug and secondary hemostasis by providing “rafts” of negatively charged surface phospholipids on which the amplification and propagation phases of plasma coagulation occur. If lost or dysfunctional platelets need to be replaced quickly, transfusion of stored donor platelets is the only widely available therapy.

It is sometimes hard to know when to transfuse platelets. Stored platelets are a complex biologic therapy, and transfusion results depend on the donor, processing, and storage. Most perioperative practices are not supported by high-quality evidence. Traditionally, it...

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