Platelet Transfusion Practices in Critically Ill Children

Nellis, Marianne; Karam, Oliver; Mauer, Elizabeth; Cushing, Melissa M.; Davis, Peter J.; Steiner, Marie; Tucci, Marisa; Stanworth, Simon; Spinella, Philip C.

doi:10.1097/ccm.0000000000003192

Cited by 66 publications

(82 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another reason is that most patients who are transfused with PC are immunocompromised and thus vulnerable to bacterial infection. 1,2 Significant numbers of septic reactions and fatal outcomes related to PC transfusion have been reported from many countries. [3][4][5][6] Various interventions to mitigate these consequences of PC transfusion have been proposed, as follows.…”

Section: Discussionmentioning

confidence: 99%

“…The major reason for this compared with red cell or plasma components is a high bacterial load derived from storing PC at 20‐24°C, which enables vigorous bacterial proliferation in PC during the preservation process. Another reason is that most patients who are transfused with PC are immunocompromised and thus vulnerable to bacterial infection . Significant numbers of septic reactions and fatal outcomes related to PC transfusion have been reported from many countries …”

mentioning

confidence: 99%

See 1 more Smart Citation

Platelet safety strategies in Japan: impact of short shelf life on the incidence of septic reactions

et al. 2020

View full text Add to dashboard Cite

BACKGROUND Transfusion‐transmitted bacterial infections (TTBIs) often have serious consequences for patients. The Japanese Red Cross (JRC) has not implemented culture screening for platelet concentrate (PC), but it has maintained a shelf life of 85 hours for PC. STUDY DESIGN AND METHODS The JRC collected reports of suspected TTBI and investigated causal relationships using PC samples and patient blood samples. PCs showing apparent abnormalities were retrieved and cultured and analyzed for bacterial growth. RESULTS The JRC analyzed 86 samples available from 135 transfused PCs with suspected TTBIs that were collected over the past 12 years; 17 (19.8%) were culture‐positive. One, 6, and 10 TTBIs developed in patients on Days 1, 2, and 3 after PC collection, respectively. Assuming that PC is transfused on the day of issue, the TTBI risk was fourfold higher on Day 3 than on Day 2, after adjusting the TTBI incidence for the number of PCs issued per day. Compared with the model of issuing all PCs on Day 3, issuing PCs with the current distribution of storage time could have decreased the TTBI incidence by 56%. During the past 8 years, the JRC retrieved 960 PC units because of apparent abnormalities, 2.8% of which were culture‐positive. CONCLUSION The short shelf life of PC is associated with a low incidence of reported TTBIs, more than half of which occurred on Day 3 relative to earlier time points. Visual inspection of PC before transfusion is crucial in detecting bacterially contaminated PC despite its low positive predictive value.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Platelet safety strategies in Japan: impact of short shelf life on the incidence of septic reactions

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In critically ill children, the most common reason platelets are given is prophylaxis for bleeding risk in patients with thrombocytopenia. In the same studies, platelet transfusions are associated with increased mortality 143,144 . In a review of 511 children on ECMO, Cashen et al 145 found that 97.1% were transfused platelets during the course of their ECMO run.…”

Section: Transfusion Thresholdsmentioning

confidence: 99%

Hematologic concerns in extracorporeal membrane oxygenation

Sniderman

Monagle

Annich

et al. 2020

Research and Practice in Thrombosis and Haemostasis

View full text Add to dashboard Cite

This ISTH “State of the Art” review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion‐related considerations, age‐ and size‐related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.

show abstract

“…In addition, during 57% (8/14) of the admissions, patients experienced bleeding; 63%(5/8) of the time, the bleeding was significant. During these PTR events, the median platelet threshold prior to transfusions was 18 × 10 9 /L (IQR:[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], and the median posttransfusion increment was 3 × 10 9 /L (IQR: 1-6). These children typically received platelets stored for a median of 4 days (IQR: 3-5 days) that were ABO matched (67%; 50/74) and apheresis products (53%; 39/74).…”

mentioning

confidence: 99%

Platelet transfusion practice and platelet refractoriness for a cohort of pediatric oncology patients: A single‐center study

Lieberman

Liu

Barty

et al. 2020

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background: Platelet transfusions are an essential aspect of supportive care for pediatric oncology patients. Data regarding the frequency of transfusions, pretransfusion thresholds, posttransfusion increments, and rate of platelet transfusion refractoriness (PTR) are lacking. Study objectives: (a) describe platelet transfusion practice for children with malignancy; (b) determine the normal platelet increment following platelet transfusion; and (c) assess rate of PTR. Methods: Inpatient pediatric oncology patients <18 years old and treated between 2009 and 2013 were identified. Data collected retrospectively included patient demographics, clinical information, laboratory values, and transfusion details. Results: Three hundred sixty-seven children were included and 144 (39%) received at least one platelet transfusion. Platelets were transfused during 25% of all inpatient admissions. The median number of platelet transfusion for any given inpatient admission was two (interquartile range [IQR]: 1-3). The median pretransfusion platelet count was 16 × 10 9 /L and posttransfusion increment was 25 × 10 9 /L. Most (79%) of the time, the pretransfusion platelet count was >10 × 10 9 /L. Older children who received ABO incompatible platelet transfusions with a longer storage duration were more likely to have a poor platelet response (increment ≤ 10 × 10 9 /L). The rate of PTR (immune and/or nonimmune) was low (8%; 11/144). Conclusions: Practical information to parents and clinicians of newly diagnosed children regarding the likelihood and frequency of platelet transfusions was determined. The rate of PTR was low, supporting the hypothesis that children receiving leukoreduced products are at a low risk of PTR.

show abstract

Platelet Transfusion Practices in Critically Ill Children

Abstract: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.

Cited by 66 publications

References 15 publications

Platelet safety strategies in Japan: impact of short shelf life on the incidence of septic reactions

Platelet safety strategies in Japan: impact of short shelf life on the incidence of septic reactions

Hematologic concerns in extracorporeal membrane oxygenation

Platelet transfusion practice and platelet refractoriness for a cohort of pediatric oncology patients: A single‐center study

Contact Info

Product

Resources

About