Objective To investigate the predictive value of thromboelastography （TEG） parameters in conjunction with platelet count （PLT） for guiding platelet transfusion in critically ill patients with fever associated with thrombocytopenia syndrome （SFTS）. Methods Sixty-two critically ill patients with fever and thrombocytopenia syndrome were selected from the infection department of a hospital. They were divided into two groups： the bleeding group （n = 30） and non-bleeding group （n = 32）. Changes in relevant indices， such as PLT and TEG， were compared between the two groups using t-test， chi-square test or non-parametric test. Binary logistic regression was employed to analyze factors predicting bleeding in critically ill patients. The efficacy of these indices in predicting bleeding was assessed by calculating the area under the receiver operating characteristic curve， determining optimal cut-off values， and comparing PLT levels with mortality rates using chi-square test after grouping based on MA cut-off value. Results First of all，the MA value and PLT were significantly lower in bleeding patients compared to non-bleeding patients （P < 0.05）， while the K value and PT were significantly higher in bleeding patients （P < 0.05）. Second of all，logistic regression analysis revealed that both MA value and PLT were significant influencing factors for hemorrhage in patients （P < 0.05）. Third of all， ROC analysis demonstrated that the area under the curve for PLT was 0.884， while for MA it was 0.890（P < 0.05）. Among these， PLT exhibited the highest specificity and MA value had the highest sensitivity， with a best cut-off value of 48.85 mm for MA. The combined index of K， MA， and PLT yielded an area under the curve of 0.941 and a Youden index of 0.77， which were higher than those obtained from individual indices. Finally， Rank sum test and Fisher exact test indicated that individuals with an MA value < 48.85 mm had lower PLT levels and higher mortality rates （P < 0.05）. Conclusion The integration of TEG and PLT demonstrates significant potential in predicting bleeding events among critically ill patients with SFTS， thereby offering valuable clinical implications for guiding prophylactic platelet transfusion in this patient population.