A randomized trial of platelet transfusions over 30 vs 120 minutes: is there an effect on post-transfusion platelet counts?

Dannaway, Douglas; Noori, Shahab

doi:10.1038/jp.2013.46

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Adult transfusions are administered over 30–60 min for platelets and over 90–120 min for red cells [16]. A clinical trial was conducted on neonates with thrombocytopenia transfusing platelets over 30 min or 2 h. The study showed that transfusions during both durations were tolerated and post transfusion platelet counts were comparable [17]. A few observational studies showed the number of platelet transfusions may associate with increased risk for IVH [18, 19].…”

Section: Discussionmentioning

confidence: 99%

Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study

et al. 2021

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Background: Prophylactic platelet transfusion has been adopted as a ubiquitous practice in management of thrombocytopenia in preterm infants to reduce the risk of bleeding. Objectives: The objectives of this study were to report the prevalence of platelet transfusion among preterm infants with thrombocytopenia and to assess the association of platelet transfusion with mortality and morbidity in this population. Methods: A cross-sectional study that utilized National Inpatient Sample for the years 2000–2017 was conducted. All preterm infants delivered nationally with birth weight (BW) <1,500 g or gestational age <32 weeks were included. Analyses were repeated after stratifying the population into 2 BW subcategories <1,000 g and 1,000–1,499 g. Logistic regression analysis was performed to adjust for confounding variables. Results: The study included 1,780,299 infants; of them, 22,609 (1.27%) were diagnosed with thrombocytopenia and 5,134 (22.7%) received platelet transfusion. Platelet transfusion was associated with significant increase in mortality (24.8 vs. 13.8%), retinopathy of prematurity (22.3 vs. 19.2%), severe intraventricular hemorrhage (18.3 vs. 10.1%), median length of hospital stays (51 vs. 47 days), and cost of hospitalization (USD 298,204 vs. USD 219,760). Increased mortality was noted in <1,000-g infants (aOR = 1.96, CI: 1.76–2.18, p < 0.001) and 1,000–1,499-g infants (aOR = 2.02, CI: 1.62–2.53, p < 0.001). Platelet transfusion increased over the years in infants with BW <1,000 g (p = 0.001) and in infants with BW 1,000–1,499 g (p < 0.001). Conclusions: Platelet transfusion is associated with increased mortality and comorbidities in premature infants. There is a trend for increased utilization of platelet transfusions over the study period.

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Section: Discussionmentioning

confidence: 99%

Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study

et al. 2021

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“…If this is one of the mechanisms, transfusing a lower volume and/or over a longer time might reduce the risk of bleeding associated with platelet transfusions. At least one randomized study in neonates has shown that transfusing platelets over 2 h or over 30 min results in the same platelet count increment 43 …”

Section: How Do Platelet Transfusions Increase Bleeding Risk?mentioning

confidence: 99%

Neonatal platelet transfusions: New evidence and the challenges of translating evidence‐based recommendations into clinical practice

Sola‐Visner

Leeman

Stanworth

2022

Journal of Thrombosis and Haemostasis

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Platelet transfusions are a common intervention for thrombocytopenia. Although the main reason for transfusing platelets is to improve hemostasis, platelets have many additional physiological roles, including interactions with immune pathways. Much of the evidence base for safe and effective transfusions has been informed by randomized trials in adult patients with hematological malignancies. Only three randomized trials have been conducted in sick neonates. These trials have indicated evidence of harm, including a significantly higher rate of death or major bleeding within 28 days after randomization for the largest trial, which enrolled 660 infants. The overall research indicates limited effectiveness of platelet transfusions to reduce bleeding risk.It is important that the results of trials are implemented into practice, but uptake of research findings into neonatal medicine remains inconsistent, as for many areas of health care. There is a need to establish which potential implementation strategies (cost-) efficiently enact change, such as audit and feedback, automated reminder systems for ordering transfusions, and use of opinion leaders. Research is exploring potential mechanisms underlying the lack of effectiveness of platelet transfusions and the increased bleeding and mortality observed in neonatal randomized trials. One potential mechanism concerns the roles of platelets to promote excessive angiogenic signals during a vulnerable period of brain development. A further hypothesis explores the effects of transfusing "adult" platelets into "neonatal" thrombocytopenic blood on primary hemostasis and immune responses.

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“…The duration of platelet infusion does not modify the response. 134 Currently, the main controversy is not related to the management of bleeding but to its prevention, in an attempt to establish the PC threshold below which bleeding would be highly probable and would warrant a prophylactic PT. Such decision is basically based on dogmas and expert opinions, with a minimal support from conclusive scientific data.…”

Section: Platelet Transfusionsmentioning

confidence: 99%

Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion

2021

Arch Argent Pediat

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Non-immune thrombocytopenia is caused by multiple pathologies; the most common causes are extra-or intrauterine infections, whereas secondary cases result from other pathologies involved in the fetal-placentalmaternal interface. This second article lists its causes and provides details of the different pathologies. Platelet transfusion is widely used in neonatology, both as treatment and as bleeding prophylaxis. However, there is no general consensus about the platelet count threshold that is convenient to indicate a transfusion or actual indications. Recent articles are commented regarding the different proposed strategies. The emphasis is on discussing the multiple adverse effects of platelet transfusions because knowledge about them is changing the paradigm for indications, suggesting that a much more restrictive policy is required.

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A randomized trial of platelet transfusions over 30 vs 120 minutes: is there an effect on post-transfusion platelet counts?

Abstract: Transfusion duration does not affect post-transfusion platelet counts in newborns. Babies of lower postmenstrual age (PMA) may have better responses to platelet transfusions. Finally, platelet transfusions over both durations are well tolerated in neonates.

Cited by 9 publications

References 11 publications

Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study

Platelet Transfusion and Outcomes of Preterm Infants: A Cross-Sectional Study

Neonatal platelet transfusions: New evidence and the challenges of translating evidence‐based recommendations into clinical practice

Neonatal thrombocytopenia: A review. II. Non-immune thrombocytopenia; platelet transfusion

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