Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital

Abstract

Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

Blood product transfusion practices in pediatric critically ill patients at a tertiary care hospital, Pakistan

“…4 Other studies have shown that most of the platelet transfusions are done for prophylactic control of bleeding at counts more than 20,000, out of which many are significantly inappropriate. 12, 13,14 Advances in technology and screening have reduced the infectious complications of blood and blood product transfusions. However, it doesn't exclude an individual from acquiring non-infectious complications which range from acute hemolytic transfusion reaction (AHTR), allergic reactions and anaphylaxis, transfusion related acute lung injury (TRALI) to alloimmunization and immunomodulation.…”

“… 4 Other studies have shown that most of the platelet transfusions are done for prophylactic control of bleeding at counts more than 20,000, out of which many are significantly inappropriate. 12 , 13 , 14 …”