In an emergency department, platelets should be considered for treatment under which criteria?

• A. Count < 20,000
• B. Count < 10,000 or active bleeding and count < 50,000
• C. Active bleeding irrespective of counts
• D. Platelets should never be treated in the ER

Answer: (B)

Transfusion decisions rely on two main triggers: when platelets are extremely low to prevent spontaneous bleeding, and when there is active bleeding that needs help with hemostasis. If platelets fall below about 10,000, prophylactic transfusion is typically indicated. If there is active bleeding and the platelet count is below about 50,000, transfusion is indicated to aid control of the bleeding. This combination captures both situations, which is why the option describing counts <10,000 or active bleeding with counts <50,000 is the best choice.

The other options don’t fit: a fixed threshold like <20,000 misses how to manage bleeding when counts are between 20,000 and 50,000; treating active bleeding “irrespective of counts” is not standard practice because platelet level still influences hemostasis; and saying platelets should never be treated in the ED is plainly incorrect.