Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Critical bleeding with haemostatic failure
Intracranial, massive, obstetric or other critical-site bleeding requires haemorrhage control and coordinated component support; waiting for an isolated threshold can be fatal.
Action: Activate the relevant major-haemorrhage pathway, control the anatomical source, warm the patient and send urgent full blood count, PT, APTT and fibrinogen with repeated or viscoelastic testing. Give platelets, plasma and fibrinogen replacement according to bleeding, results and the local pack protocol; correct hypocalcaemia and anticoagulants and move from empirical to targeted therapy as soon as data are available.
Synopsis
Choose the correct haemostatic component for thrombocytopenia, factor deficiency or hypofibrinogenaemia, apply UK thresholds and avoid ineffective or harmful prophylactic transfusion.
Platelets treat or prevent bleeding caused by inadequate platelet number or function; plasma replaces multiple soluble coagulation factors; cryoprecipitate provides concentrated fibrinogen.
For clinically significant non-major bleeding, NICE recommends platelet transfusion when the platelet count is below 30 × 10⁹/L.
For severe bleeding or bleeding in a critical site, use a higher platelet threshold up to 100 × 10⁹/L according to severity and location.
Key red flags
Bleeding into the brain, eye, airway, pericardium or another critical site warrants a higher platelet target and immediate specialist haemostasis support.
Investigation priorities
01
First-line: platelet count and trendFirst stepFirst line
Quantify thrombocytopenia and establish whether it is stable, recovering or being consumed.
02
First-line: PT, APTT and fibrinogenFirst line
Identify multiple-factor deficiency, consumption and hypofibrinogenaemia.
Management branches
Non-major platelet bleedingTreat by severity and count
Clinically significant bleeding occurs with thrombocytopenia.
Assess site and severity, send count, coagulation, fibrinogen and film and treat the cause.
If the count is below 30 × 10⁹/L, give one adult therapeutic dose; use a higher threshold up to 100 for severe or critical-site bleeding.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.
NICE NG24: platelet transfusionCurrent UK bleeding, prophylactic and procedural platelet thresholds and single-dose reassessment.