Evaluation of the Association of Platelet Count, Mean Platelet Volume, and Platelet Transfusion With Intraventricular Hemorrhage and Death Among Preterm Infants

Abstract

ImportancePlatelet transfusion is commonly performed in infants to correct severe thrombocytopenia or prevent bleeding. Exploring the associations of platelet transfusion, platelet count (PC), and mean platelet volume (MPV) with intraventricular hemorrhage (IVH) and in-hospital mortality in preterm infants can provide evidence for the establishment of future practices.ObjectivesTo evaluate the associations of platelet transfusion, PC, and MPV with IVH and in-hospital mortality and to explore whether platelet transfusion–associated IVH and mortality risks vary with PC and MPV levels at the time of transfusion.Design, Setting, and ParticipantsThis retrospective cohort study included preterm infants who were transferred to the neonatal intensive care unit on their day of birth and received ventilation during their hospital stay. The study was conducted at a neonatal intensive care unit referral center in Beijing, China, between May 2016 and October 2017. Data were retrieved and analyzed from December 2020 to January 2022.ExposuresPlatelet transfusion, PC, and MPV.Main Outcomes and MeasuresAny grade IVH, severe IVH (grade 3 or 4), and in-hospital mortality.ResultsAmong the 1221 preterm infants (731 [59.9%] male; median [IQR] gestational age, 31.0 [29.0-33.0] weeks), 94 (7.7%) received 166 platelet transfusions. After adjustment for potential confounders, platelet transfusion was significantly associated with mortality (hazard ratio [HR], 1.48; 95% CI, 1.13-1.93; P = .004). A decreased PC was significantly associated with any grade IVH (HR per 50 × 103/μL, 1.13; 95% CI, 1.05-1.22; P = .001), severe IVH (HR per 50 × 103/μL, 1.16; 95% CI, 1.02-1.32; P = .02), and mortality (HR per 50 × 103/μL, 1.74; 95% CI, 1.48-2.03; P < .001). A higher MPV was associated with a lower risk of mortality (HR, 0.83; 95% CI, 0.69-0.98; P = .03). The platelet transfusion–associated risks for both IVH and mortality increased when transfusion was performed in infants with a higher PC level (eg, PC of 25 × 103/μL: HR, 1.20; 95% CI, 0.89-1.62; PC of 100 × 103/μL: HR, 1.40; 95% CI, 1.08-1.82). The platelet transfusion–associated risks of IVH and mortality varied with MPV level at the time of transfusion.Conclusions and RelevanceIn preterm infants, platelet transfusion, PC, and MPV were associated with mortality, and PC was also associated with any grade IVH and severe IVH. The findings suggest that a lower platelet transfusion threshold is preferred; however, the risk of a decreased PC should not be ignored.

The Causal Relationship Between Blood Cell Indices and 28-Day Mortality in Sepsis: A Bidirectional Mendelian Randomization Analysis

“…While strikingly, we found a remarkable and consistent genetic association between PDW and 28-day mortality in sepsis risk in both UVMR and MVMR models. However, no signi cant associations of genetic liability to other BCIs were observed, which is inconsistent with previous ndings [11][12][13][14][15] .…”

“…Traditionally, platelets are typically known for their role in hemostasis; however, recent evidence highlights their signi cant involvement in sepsis, in ammation, and immune responses 6,20 . Various cohort studies have emphasized the importance of platelet parameters such as PLC, PDW, and MPV in the early diagnosis and prognosis of sepsis 12,13,[36][37][38] , although some studies question their prognostic value 16,39 .…”

“…Recent observational cohort studies have identi ed several common BCIs such as erythrocyte distribution width (RDW), platelet count (PLC), mean platelet volume (MPV), platelet distribution width (PDW), and monocyte distribution width (MDW), as potentially valuable tools for early sepsis screening and prognostic assessment [11][12][13][14][15] . However, the prognostic value of some BCIs in sepsis remains a subject of debate 16,17 .…”

Transfusion of Adult, but Not Neonatal, Platelets Promotes Monocyte Trafficking in Neonatal Mice

“…1 There are conflicting data on whether the degree of thrombocytopenia is associated with major bleeding risk in neonates and on whether neonatal platelet transfusions increase or decrease the risk of major bleeding episodes. 2–4 A recent study of 1221 preterm infants noted a lower platelet count was significantly associated with increased risks of hemorrhage and mortality, 2 but whether platelet transfusions are beneficial in neonates may be dependent on many factors. What is more clear is that multiple platelet transfusions to neonates is a risk factor for death.…”

Separation of platelets by size in a microfluidic device based on controlled incremental filtration

“…Such a capability would be particularly useful in the pediatric setting, where the demand for high quality, low-volume PLT transfusions is most urgent. 44,45,54,55…”