Severe thrombocytopenia and patterns of bleeding in neonates: results from a prospective observational study and implications for use of platelet transfusions

Muthukumar, P; Venkatesh, Vidheya; Curley, Anna; Kahan, Brennan C; Choo, Louise; Ballard, S.; Clarke, Paul; Watts, Troy; Roberts, Irene; Stanworth, Simon

doi:10.1111/j.1365-3148.2012.01171.x

Cited by 57 publications

(38 citation statements)

References 27 publications

(43 reference statements)

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“…To our knowledge, this is the first randomized controlled prospective study to investigate this issue. The number of transfusions administered was low in both groups, compared with some studies addressing thrombocytopenia in neonates [2,12]. This finding suggests that adhering to a platelet transfusion guideline, whether based on platelet count or mass, might reduce the transfusion rate compared to relying solely on the clinical judgment of each neonatologist.…”

Section: Discussioncontrasting

confidence: 43%

Transfusing neonates based on platelet count vs. platelet mass: A randomized feasibility-pilot study

Mackley

Clearly

et al. 2013

Platelets

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The objective of this study was to obtain pilot data on which to judge the feasibility and sample size needed for a future comparative-effectiveness trial of platelet transfusions in the NICU. We conducted a limited-scope pilot trial in which neonates were randomized to receive platelet transfusions based on platelet mass vs. platelet count, using preset "transfusion-trigger" values. Analysis included parental consent rate, number of platelet transfusions given, bleeding episodes recorded, and mortality rate. Statistical analysis included ANOVA and Chi-square. A convenience sample of 30 were randomized; 15 per group. No differences were found between groups in gestational age, birth weight, race, gender or clinical diagnoses. The study consent rate was 52% (30/58). No differences were found in number of platelet transfusions received, bleeding episodes, or mortality. Lack of a trend in transfusion-reduction resulted in inability to estimate the number needed in a future comparative-effectiveness trial. Using platelet mass, rather than platelet count, for a NICU platelet transfusion trigger is feasible. However, any future comparative-effectiveness trial, testing the hypothesis that a platelet mass-based trigger reduces the transfusion rate will likely require a very large sample size.

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Section: Discussioncontrasting

confidence: 43%

Transfusing neonates based on platelet count vs. platelet mass: A randomized feasibility-pilot study

Mackley

Clearly

et al. 2013

Platelets

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“…A recent prospective study of neonatal platelet transfusion practices [Platelets for Neonatal Transfusion - Study 1 (PlaNeT-1)] [12] showed no clear relationship between major bleeding and platelet counts, and further analysis of all bleeding events (including minor bleeds) indicated no evidence for a significant increase in rates of bleeding with severe thrombocytopenia [13]. The only randomised controlled trial of platelet transfusion thresholds did not find an increased risk of bleeding with the lower threshold (50 × 10 9 /l) [8], although the transfusion thresholds evaluated were significantly higher than those used in current clinical practice [4].…”

Section: Risks and Benefits Of Plateletsmentioning

confidence: 99%

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

et al. 2014

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Introduction: Neonatal thrombocytopenia is a common and important clinical problem in preterm neonates. A trial assessing clinically relevant outcomes in relation to the different platelet count thresholds used to trigger transfusion has never been undertaken in preterm neonates with severe thrombocytopenia. Objectives: Platelets for Neonatal Transfusion - Study 2 (PlaNeT-2) aims to assess whether a higher prophylactic platelet transfusion threshold is superior to the lower thresholds in current standard practice in reducing the proportion of patients who have a major bleed or die up to study day 28. Methods: PlaNeT-2 is a two-stage, randomised, parallel-group, superiority trial. PlaNet-2 compares clinical outcomes in preterm neonates (<34 weeks' gestation at birth) randomised to receive prophylactic platelet transfusions to maintain platelet counts at or above either 25 × 10⁹/l or 50 × 10⁹/l. The primary outcome measure is the proportion of patients who either die or experience a major bleed up to and including study day 28. A total of 660 infants will be randomised. Results and Conclusions: This trial will help define optimal platelet transfusion support for severely thrombocytopenic preterm neonates by evaluating the risks and benefits of two different prophylactic neonatal platelet transfusion thresholds.

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“…Ninety-one per cent of neonates with platelet counts <20×10 9 /l did not develop major haemorrhage of any type. In a subsequent analysis of all bleeding, a lower platelet count, in itself, was not a strong predictor of increased bleeding risk; in contrast gestational age <34 weeks, early onset of severe thrombocytopaenia (within 10 days of birth) and NEC were found to be the strongest predictors for an increased number of bleeding events 13. Finally, in this study, 81% of neonates received platelet transfusions where the main reason recorded for transfusion was the low platelet count and not the clinical condition of the neonate, or bleeding 11…”

Section: Clinical Studiesmentioning

confidence: 80%

Do we know when to treat neonatal thrombocytopaenia?

Venkatesh

Curley

Clarke

et al. 2013

Arch Dis Child Fetal Neonatal Ed

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Severe thrombocytopenia and patterns of bleeding in neonates: results from a prospective observational study and implications for use of platelet transfusions

Cited by 57 publications

References 27 publications

Transfusing neonates based on platelet count vs. platelet mass: A randomized feasibility-pilot study

Transfusing neonates based on platelet count vs. platelet mass: A randomized feasibility-pilot study

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Do we know when to treat neonatal thrombocytopaenia?

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