Platelet Transfusion Thresholds Among Children Admitted to a Pediatric Intensive Care Unit

Abstract

ObjectiveTo evaluate the threshold for platelet transfusion in children admitted to a pediatric intensive care unit (PICU). This is a retrospective chart review study, conducted at our tertiary level PICU and is related to critically ill pediatric patients who required platelet transfusion.MethodsWe retrieved the target patient population data from our blood bank database. The patients were subdivided into four subgroups: hematologic (hematologic malignancies, bone marrow suppression, hemolytic anemia, and sickle cell disease), surgical (post-surgical, trauma and acute bleeding), the unstable fraction of inspired oxygen (FiO2 > 0.6 and/or inotropic support), and the stable patients. Critically ill children between one month and 21 years of age were enrolled. We excluded patients who underwent extracorporeal membrane oxygenation (ECMO).ResultsA total of 197 transfusion episodes in 64 patients were analyzed. The distribution of transfusions episodes included hematologic 82% (n=161), surgical 7% (n=13), unstable 8% (n=16), stable 3% (n=7). The mean standard deviation (SD) of pre-transfusion platelet count (x1000) in all the patients and children in hematologic, surgical, unstable and stable groups were 29 (22), 29 (19), 47 (46), 28 (19), and 24 (14), respectively. The platelet count threshold for transfusion among the surgical group was higher compared to hematologic and unstable groups (p <0.001; analysis of variance (ANOVA) with multiple comparison tests). The mean platelet count during all episodes increased from 29 (22) to 71 (57) (p <0.05; paired t-test). The post-transfusion increase in platelet count was significantly higher among surgical and unstable patients compared to hematologic patients (p <0.001; ANOVA with multiple comparison tests).ConclusionThe most common indication for platelet transfusion in the pediatric intensive care unit (PICU) is the underlying hematologic condition. The platelet count threshold for transfusion varied with the clinical condition and is higher among the surgical patients. The rise of platelet count after transfusion was higher among the surgical and unstable patients.

Overview of Plasma and Platelet Transfusions in Critically Ill Children

“…There is a wide variation in the practice of prophylactic platelet transfusion in children, and most of the clinical practice guidelines are based on expert opinion. Often the platelet count threshold for transfusion varied depending on the geographic location of clinical practice (29), with underlying clinical indication and diagnosis (4,5,64,65). The clinical practice of platelet transfusion for hypoproliferative thrombocytopenia cannot be applicable in thrombocytopenia due to immune-mediated platelet destruction.…”

A Clinical Audit of blood component transfusion practices in Paediatric intensive care unit of a Tertiary Care Hospital, Rawalpindi

“…7 There has been limited data about evidence-based guidelines regarding platelet transfusion in the paediatric age group and this may end up in transfusing at a wide range of thresholds with reference to studies conducted on the adult population. 1,8 Blood transfusions should be done judiciously keeping in view their scarcity and significance in health care facilities and minimizing the risks associated with transfusions. Although several countries have developed guidelines for effective blood transfusion practices, there is still a significant rate of inappropriate transfusions being done globally.…”

Plasma and Platelet Transfusion Strategies in Critically Ill Children With Malignancy, Acute Liver Failure and/or Liver Transplantation, or Sepsis: From the Transfusion and Anemia EXpertise Initiative–Control/Avoidance of Bleeding

“…An observational study of 405 children reported that 9% experienced clinically relevant bleeding, and platelets were transfused in 16% with a median (IQR) platelet count 181 × 10 9 /L (108–257 × 10 9 /L)(36). Oncology patients represent a common cohort of patients who receive platelet transfusions in the PICU (2, 37). A recent point prevalence study of platelet transfusion practice of 237 inpatient PICU oncology patients found that 30% of transfusions were administered for therapeutic indications (major bleeding 9%, minor bleeding 16%) at a median (IQR) pretransfusion platelet count of 56 × 10 9 /L (37–89 × 10 9 /L) and that 60% were administered prophylactically at thresholds of greater than 20 × 10 9 /L (2).…”