American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the threshold for platelet transfusion in central line placement?

1. 10K

2. 20K/microL

3. 30K/microL

4. 50K/microL

The correct answer is: 20K/microL

The threshold for platelet transfusion prior to central line placement is primarily guided by the risk of bleeding associated with the procedure. A platelet count of 20,000/microL (or 20K) is generally recognized as the minimum safe level for performing invasive procedures, including the placement of a central line. At this platelet count, while there remains some risk of bleeding, it is considered manageable in most clinical settings. Transfusion above this threshold ensures that the platelet count is elevated enough to minimize the risk of significant bleeding complications during and after the procedure. In higher-risk patients or in situations where difficulty in obtaining hemostasis is anticipated, practitioners may choose to aim for a higher platelet count, but 20K is widely accepted as the standard threshold for patients who are not experiencing severe coagulopathy or other bleeding disorders. In contrast, lower thresholds (such as 10K) could place the patient at a greater risk for complications during the procedure, while higher thresholds like 30K or 50K may be more cautious but are not necessary for central line placement in most straightforward cases. The clinical judgment of the healthcare provider, along with consideration of the specific patient’s situation and the urgency of the procedure, contributes to the final decision regarding platelet