Platelet Transfusion Practices Among Neonatologists in the United States and Canada: Results of a Survey

Abstract

There is great variability in platelet transfusion practices among US and Canadian neonatologists, suggesting clinical equipoise in many clinical scenarios. Prospective randomized clinical trials to generate evidence-based neonatal platelet transfusion guidelines are needed.

Transfusion Related Acute Lung Injury in the Canadian Paediatric Population

“…Published surveys concerning blood transfusion practices and policies for Canadian paediatric patients indicate that, for neonates, a minority of centres use washed or volume-reduced red blood cell units and approximately one-half use volume-reduced platelets (40)(41)(42)(43). Adoption of these practices could possibly contribute to a lower incidence of TRALI in neonates.…”

Neonatal Thrombocytopenia: A Common Clinical Problem

“…<50,000/µl). Platelet transfusion is recommended for any neonate with active bleeding and a platelet count <100,000/µl (33,34). For neonates who are treated by extracorporeal membrane oxygenation and those requiring major surgery, most centers advocate keeping the platelet count >100.000/µl (28).…”

Platelet transfusions in neonates: questions and answers

“…When only a subset of extremely low birthweight neonates (<1000 g at delivery) were considered, 73% had one or more platelet counts below 150,000/µl [3]. Among all thrombocytopenic preterm neonates, 25-38% will have blood platelet counts less than 50,000/µl (i.e., severe thrombocyto penia) and will probably receive PTXs [3][4][5]. Thus, between 2 and 8% of all preterm neonates admitted to an NICU will receive a PTX [5], with extremely low birthweight neonates given PTX much more frequently (45% in one report [3]).…”

“…Since only one randomized controlled trial studying PTXs in preterm neonates has been reported [6], the practice of neonatal PTXs is based almost entirely on 'level 4 evidence' (i.e., expert opinion and reasoning), and practices vary widely [5]. Andrew et al's randomized clinical trial enrolled preterm neonates during the first week of life and assigned them to either a group in which PTXs were given liberally to keep the blood platelet count within the normal range (i.e., to receive a PTX whenever the blood platelet count fell below 150,000/µl), or a group that received a PTX for specific reasons related to true thrombocytopenia (i.e., clinical concern about bleeding or whenever the blood platelet count fell below 50,000/ µl) [6].…”

“…It is widely agreed that the blood platelet count should not fall below 50,000/µl in preterm neonates who exhibit active bleeding or are at a great risk of bleeding (e.g., when a surgical or invasive procedure, such as a lumbar puncture, is to be performed) [4,5]. For these neonates, many physicians elect to give PTXs whenever the platelet count falls below 100,000/µl and expand the definition of 'great risk of bleeding' to include neonates receiving indomethacin, neonates with grade II intraventricular hemorrhage, neonates with sepsis and neonates with necrotizing enterocolitis -decisions not supported by definitive or even highly suggestive data/information from properly designed and conducted clinical trials [5].…”