Neonatal Platelet Transfusions: Starting Again

Moore, Carmel Maria; Curley, Anna

doi:10.1016/j.tmrv.2021.06.003

Cited by 13 publications

(6 citation statements)

References 70 publications

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“…Withholding transfusions until the count falls below 25,000/µL appears to be better for patient outcomes. 16 17 18 19 20 The explanation might involve damaging effects of donor platelets in the lung and other organs, 17 18 20 which might have contributed to the severe lung damage seen in all eight of our high transfusion recipients. Whether preventing refractoriness could occur by transfusing only ABO-identical platelets is highly speculative and awaits further study.…”

Section: Discussionmentioning

confidence: 96%

“…the USA [14,15] but this may not be the best practice. Withholding transfusions until the count falls below 25,000/µL appears to be better for patient outcomes [16][17][18][19][20]. The explanation might involve damaging effects of donor platelets in the lung and other organs [17,18,20], which might have contributed to the severe lung damage seen in all eight of our high transfusion recipients.…”

Section: Manuscriptmentioning

confidence: 86%

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Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions

et al. 2023

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Objective: A few patients in neonatal intensive care units (NICU) receive numerous platelet transfusions. These patients can become refractory, defined as transfusions of ≥10 mL/kg failing to increase the platelet count by at least 5000/µL. Causes of, and best treatments for, platelet transfusion refractoriness in neonates have not been defined. Study Design: Multi-NICU multi-year retrospective analysis of neonates receiving >25 platelet transfusions. Results: Eight neonates received 29 - 52 platelet transfusions. All eight were blood group O. Five had sepsis, four were very small for gestational age, four had bowel resections, two Noonan syndrome, two had cytomegalovirus infection. All eight had some (19 - 73%) refractory transfusions. Many (2 - 69%) of the transfusions were ordered when the platelet count was >50,000/µL. Higher post-transfusion counts occurred after ABO-identical transfusions (p=0.026). Three of the eight had late NICU deaths related to respiratory failure; all five survivors had severe bronchopulmonary dysplasia requiring tracheostomy for prolonged ventilator management. Conclusion: Neonates who are high users of platelet transfusions appear to be at high risk for poor outcomes, especially respiratory failure. Future studies will examine whether group O neonates are more likely to develop refractoriness and whether certain neonates would have a higher magnitude of post-transfusion rise if they received ABO identical donor platelets.

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Section: Discussionmentioning

confidence: 96%

Section: Manuscriptmentioning

confidence: 86%

Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions

et al. 2023

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“…Thus, animals with low WBC are at high risk to diseases, while high WBC presents high resistance to diseases (Soetan et al, 2013). According to Moore et al (2021), blood platelets are key blood clotting factor, and its low level will lead to prolonged clot-formation resulting in excessive blood loss during injury. The decreased platelet count recorded by the codeine treated group in this study shows that codeine administration could lead to thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

Haematopoietic Potential of Rice Husk Extract in Codeine Administered Male Wistar Rats

Nnadiukwu

Onyeike

Patrick-Iwuanyanwu

et al. 2023

IJNFS

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Oryza sativa (rice) is a widely consumed staple grain with significant amount of fibre, carbohydrate, and trace amount of other biomolecules such as minerals and vitamins. Thus, it’s a good energy source. The pre-clinical and clinical investigations of rice hull has revealed its numerous health benefits. Utilization of rice products as dietary supplements, additives and pharmacological adjuvants has become a global trend. Rice husk (RH), is a by-product of rice milling generated in tremendous quantity. Considering the global trend in codeine consumption especially by the youths, this study adopted codeine as a drug of abuse as against its therapeutic use as an analgesic. The study explored the haematopoietic potential of rice husk methanol extract (RHME) in codeine-administered male Wistar rats. A total of thirty-six (36) rats weighing between 100-110g were procured and assembled into 6 groups of 6 rats. Group I was the negative control (NC), Group II received codeine at 10mg/kg body weight, Group III received 10mg/kg body weight of RHME, while Groups IV, V, and VI received codeine with RHME concurrently but at three different concentrations of 250, 500, and 1000mg/kg respectively. After 30 days of treatment, blood samples of the specimens were subjected to haematological assay. From the assessment, codeine administration significantly decreased the haematological indices (PCV, haemoglobin, RBC, WBC, platelets, neutrophil, eosinophil, lymphocyte and monocyte), while RHME administration significantly upregulated the altered blood parameters concentration. Thus, RH showed haematopoietic efficacy and should be considered a possible therapeutic for prevention and/or management of anaemia as well as boosting of key haematology indices.

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“…Major developmental differences exist between neonates, especially in preterm infants and adults [22]. Therefore, the transfusion of adult-derived blood products may disrupt neonatal hemostatic and immune homeostasis due to pro-inflammatory effects [22,23]. A restrictive threshold of 25 × 10 3 per mm 3 for platelet transfusion proved to be less harmful than a liberal approach in nonbleeding premature infants [17].…”

Section: Discussionmentioning

confidence: 99%

“…An adequate bleeding risk assessment is critical for therapeutic management and long-term patient outcomes, and this report clearly suggests that viscoelastography holds promise for optimizing platelet administration, even in cases of severe thrombocytopenia. Furthermore, based on the emerging evidence in neonatal transfusion medicine that "less is probably more," we should implement the use of viscoelastic assays for the hemostatic monitoring of neonates at higher risk of bleeding [17,23,33].…”

Section: Discussionmentioning

confidence: 99%

Individualized Bleeding Risk Assessment through Thromboelastography: A Case Report of May–Hegglin Anomaly in Preterm Twin Neonates

et al. 2021

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May–Hegglin anomaly (MHA) is a rare autosomal dominant disorder in the spectrum of myosin heavy chain-related disorders (MYH9-RD), characterized by congenital macrothrombocytopenia and white blood cell inclusions. MHA carries a potential risk of hemorrhagic complications. Bleeding diathesis is usually mild, but sporadic, life-threatening events have been reported. Data regarding the clinical course and outcomes of neonatal MYH9-RD are limited, and specific guidelines on platelet transfusion in asymptomatic patients are lacking. We present monochorionic twins born preterm at 32 weeks of gestation to an MHA mother; both presented with severe thrombocytopenia at birth. Peripheral blood smear demonstrated the presence of macrothrombocytes, and immunofluorescence confirmed the diagnosis of MHA. Close clinical monitoring excluded bleeding complications, and serial hemostatic assessments through a viscoelastic system demonstrated functionally normal primary hemostasis in both patients. Therefore, prophylactic platelet transfusions were avoided. Whole DNA sequencing confirmed the pathogenetic variant of MHA of maternal origin in both twins. Thromboelastography allowed real-time bedside bleeding risk assessment and supported individualized transfusion management in preterm newborns at risk of hemostatic impairment. This report suggests that dynamic and appropriate clotting monitoring may contribute to the more rational use of platelets’ transfusions while preserving patients with hemorrhagic complications and potential transfusion-related side effects.

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Neonatal Platelet Transfusions: Starting Again

Cited by 13 publications

References 70 publications

Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions

Neonatal Intensive Care Unit Patients Receiving More Than 25 Platelet Transfusions

Haematopoietic Potential of Rice Husk Extract in Codeine Administered Male Wistar Rats

Individualized Bleeding Risk Assessment through Thromboelastography: A Case Report of May–Hegglin Anomaly in Preterm Twin Neonates

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