Transfusion-related cerebral ischemia as a result of plateletpheresis is rarely reported. The pathogenesis of this condition is not fully understood. Not all transfusion recipients of plateletpheresis components develop cerebral ischemia even though high platelet Pselectin expression is present in the donors. Here we report such an incident of two female patients with chronic aplastic anemia, who had a medical history of cerebral infarction and recovered through therapies. After transfusion of plateletpheresis components these two patients, who had high levels of P-selectin expression, developed transient ischemia attack (TLA) and cerebral infarction, respectively. The patient with T1A recovered from the incident when transfusion ceased. The other patient with cerebral infarction recovered in about two months through anti-thrombosis therapy. In addition, instruments (e.g., MCS+, Haemonetics) can cause platelet activation to various degrees (between 1.14% to 70.9%) during plateletphresis. Thus, for the patient who had a history of cerebral vascular disorder, it is necessary to select one with a low activation rate during plateletpheresis. The platelet and vascular endothelium are known to be important elements in the condition of cerebral ischemia. On the basis of atherosclerosis, platelet activation plays an important role in the initiation of thrombotic complication.