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

Abstract

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.

Postnatal treatment for children with fetal and neonatal alloimmune thrombocytopenia: a multicentre, retrospective, cohort study

“…The safety and benefits of platelet transfusions in neonates have been questioned after a large, randomised trial in preterm neonates showed that a restrictive transfusion policy (transfusion at <25 × 10⁹ platelets per L) was associated with an improved outcome compared with a more liberal strategy (transfusion at <50 × 10⁹ platelets per L). 31,32 Whether platelet transfusions in neonates with FNAIT could also have deleterious effects is not known and requires further investigation. As shown in this study, platelet counts in most neonates with FNAIT increased to more than 50 × 10⁹ platelets per L in the first week of life.…”

State of the art, trends, hotspots, and prospects of injection materials for controlling bleeding

“…Some terminology here suggests that blue clustering is methodologically relevant and focuses on the relationship of the disease to the process of platelets change. 57,[74][75][76][77] The yellow subnetwork is the smallest cluster and contains 21 keywords. The most common keyword is "platelet transfusion", which appears 82 times and has a total link strength of 159.…”

“…From 2003 to 2022, 3552 authors from 51 countries were involved in 622 publications related to IHM. The most active authors of publications are shown in Table 2, with Chinese authors accounting for 66.67% of the 15 authors, the rest being from the USA, showing that China and the United States are prominent in research on IHM, working on the development of novel injectable materials for haemostasis 51–54 and exploring mechanisms related to platelet transfusion 55–58 . Guo Baolin (24, 0.59%) from China has the most publications in this area, followed by Liang Yongping (14, 0.34%) and Zhao Xin (10, 0.24%), who also have the highest number of citations to their papers.…”

“…The other main keywords in the blue cluster are anticoagulation, antiplatelet therapy, blood platelets, cancer, clopidogrel, desmopressin, fibrinolysis, haemorrhage, haemorrhage, intracerebral haemorrhage, microparticles, sepsis, surgery, thrombocytopenia, thrombopoietin, thrombosis, tranexamic acid, transfusion, trauma, traumatic brain injury. Some terminology here suggests that blue clustering is methodologically relevant and focuses on the relationship of the disease to the process of platelets change 57,74–77 …”

“…The most active authors of publications are shown in Table 2 , with Chinese authors accounting for 66.67% of the 15 authors, the rest being from the USA, showing that China and the United States are prominent in research on IHM, working on the development of novel injectable materials for haemostasis 51 , 52 , 53 , 54 and exploring mechanisms related to platelet transfusion. 55 , 56 , 57 , 58 Guo Baolin (24, 0.59%) from China has the most publications in this area, followed by Liang Yongping (14, 0.34%) and Zhao Xin (10, 0.24%), who also have the highest number of citations to their papers. Zhao Xin has the highest average number of paper citations of all authors and the value of his research at IHM is of most interest to the scholarly community.…”