© 2015 AABB. BACKGROUND Prophylactic platelet (PLT) transfusions are often administered to patients before bronchoscopy or bronchoalveolar lavage (BAL) to prevent bleeding. There is a paucity of data to validate this approach, with a commonly suggested PLT transfusion threshold of fewer than 50 × 109/L, largely based on expert opinion. We conducted a retrospective study on the incidence of bleeding complications in patients with thrombocytopenia undergoing bronchoscopy. STUDY DESIGN AND METHODS We identified 150 consecutive patients with PLT counts of not more than 100 × 109/L who underwent bronchoscopy and/or BAL from January 2009 to May 2014 at our institution. The British Thoracic Society (BTS) guidelines were used to categorize bleeding associated with bronchoscopy. RESULTS Infection (40%) was the primary indication for bronchoscopy with BAL. Fifty-eight of 89 (65%) patients with baseline PLT counts of not more than 50 × 109/L received prophylactic transfusions compared to 8% of those with PLT counts of more than 50 × 109/L. The PLT count did not increase to more than 50 × 109/L in many patients who received transfusions. Seventy-two patients had counts of less than 50 × 109/L at the time of bronchoscopy, with 15 patients having counts of less than 20 × 109/L. Only one patient with a PLT count of 61 × 109/L had bleeding that required continuous suctioning but then resolved spontaneously (termed "mild bleeding" by BTS criteria). Bloody lavage that resolved spontaneously without continuous suctioning (termed "no bleeding" by the BTS criteria) was observed in nine (6%) patients. CONCLUSION The very low incidence of bleeding complications from bronchoscopy with or without BAL even in patients with PLT counts of not more than 30 × 109/L (no episodes of clinically significant bleeding in 35 patients) demonstrates that bronchoscopy can be done safely in patients with severe thrombocytopenia.