Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions

Vecchio, Antonio Del; Sola, Martha C.; Theriaque, Douglas W.; Hutson, Alan D.; Kao, Kuo-Jang; Wright, Dale; Garcı́a, Marı́a Guadalupe; Pollock, Bradley H; Christensen, Robert D.

doi:10.1046/j.1537-2995.2001.41060803.x

Cited by 109 publications

(105 citation statements)

References 33 publications

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“…Thus, whether the longer bleeding times among the earliest gestation neonates contribute in any way to hemorrhages remains speculative. 11,12 Many recent reports, [13][14][15][16][17] including studies by our group, [14][15][16][17] indicate that neonatologists sometimes order platelet transfusions for nonbleeding neonates whose platelet counts are in the 100 000 to 150 000 per microliter range. This range is sometimes called 'mild' thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, several publications have begun to define risks of platelet transfusions in neonates. [13][14][15][16][17][18] Thus, it is possible that nonbleeding neonates with mild thrombocytopenia who receive platelet transfusions are subjected to transfusion risks but derive no transfusion benefits. In the present study, we found no prolongation of the bleeding time among neonates with mild thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

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Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

et al. 2008

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Objective: The template bleeding time is a test used to assess the hemostatic effectiveness of platelet/endothelial interactions. A modified template bleeding time, described over 15 years ago by Andrew et al., has been used to test this aspect of hemostasis in term and preterm infants, but questions remain regarding the effect of gestational age and postnatal age on results. The effect of the platelet count (platelets per microliter blood) and the circulating platelet mass (nl platelets per microliter blood) on the bleeding time of neonatal intensive care unit (NICU) patients also require better definition.Study Design: We measured template bleeding times on 240 neonates at Ospedale A Perrino, in Brindisi, Italy; studying groups of n ¼ 60 at the following gestational ages; <28 weeks, 29 to 32 weeks, 33 to 37 weeks and X38 weeks. In each group of 60 neonates, 20 were studied on the first day after birth, 20 were studied on day 10 and 20 were studied on day 30. A multivariate analysis was performed to examine various associations with bleeding time.Result: Bleeding times, on the first day of life, were shorter as gestational age increased. Those born <33 weeks gestation had bleeding times about twice that of those X38 weeks (P<0.001). Bleeding times tended to shorten between days 1 and 10. Little or no further shortening occurred between days 10 and 30, and by day 30 they were not statistically different between the various gestational age groups. No independent effect on bleeding time could be ascribed to gender, platelet count or circulating platelet mass, but independent effects were found for hematocrit (P<0.02) and gestational age (P<0.001). Conclusion:On the first day of life, preterm neonates have a longer bleeding time than do term neonates. By day of life 10, the bleeding times at all gestational ages are shorter and are indistinguishable on the basis of gestational age at birth. Additionally, since platelet counts as low as 110 000 per microliter did not prolong the bleeding time, we see no benefit of administering a platelet transfusion to a stable, nonbleeding, NICU patient with mild thrombocytopenia (platelet count 100 000 to 150 000 per microliter).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

et al. 2008

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“…22 They are also recommended as prophylaxis against bleeding if the count falls sufficiently low. [23][24][25] Precisely how low to permit a platelet count to fall in an ELBW neonate before ordering a platelet transfusion is not known. We found that platelet transfusions were nearly always given for prophylaxis against bleeding rather than to treat active bleeding.…”

Section: Discussionmentioning

confidence: 99%

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Henry²,

et al. 2006

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Objectives: Thrombocytopenia is common in neonatal intensive care units (NICU), with 18 to 35% of patients developing this problem before hospital discharge. It might be even more common among extremely low birth weight neonates (ELBW, p1000 g birth weight). However, little is known about thrombocytopenia in the ELBW population. We sought to determine the incidence, timing, causes, platelet transfusions given, and outcomes of thrombocytopenia among ELBW neonates. Results: Multiple platelet counts were obtained in all 284 (range, 4 to 441 platelet counts/patient). Of the 284, 208 (73%) had one or more platelet counts p150 000/ml. Most were detected during the first days of life; 80% were detected during the first week and only 20% were detected thereafter. Thrombcytopenia was more common among the smallest patients; 85% incidence among those p800 g, 60% among those 801 to 900 g, and 53% among those 901 to 1000 g. Platelet transfusions were given to 129 of the 208 thrombocytopenic neonates. More than 90% were given prophylactically (the patient was not bleeding). The mortality rate among those that received platelet transfusions was twice that of those that received no platelet transfusions (P<0.01). In 48% of cases, the cause of the thrombocytopenia went undiagnosed. The most common explanations were being small for gestational age or delivered to a hypertensive mother, DIC, bacterial infection, fungal infection, and necrotizing enterocolitis, respectively. Conclusions:We observed thrombocytopenia among ELBW neonates at a rate more than twice that reported among the general NICU population. Much remains to be discovered about the etiology and best treatments of thrombocytopenia among ELBW neonates.

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“…However, transfusions unquestionably carry risks, and multiple transfusions compound these risks. [3][4][5][6][7] It is highly probable that some transfusions given to Neonatal Intensive Care Unit (NICU) patients are not necessary. Such transfusions, although ordered with good intentions, might convey no benefits to the recipient, but nevertheless carry risks.…”

Section: Introductionmentioning

confidence: 99%

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

et al. 2008

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Objective: We critically reviewed every NICU blood component transfusion (packed erythrocytes, platelets, frozen plasma (FP) and cryoprecipitate) administered during a one-year period. This was done to determine the proportion of transfusions given out of compliance with the Intermountain Healthcare transfusion guidelines, and to look for patterns of noncompliance that could be addressed by quality improvement measures. Result: During 2006 the three NICUs cared for 1759 neonates. Seventeen percent of these received one or more (median 3) erythrocyte transfusions, 4% received one or more (median 3) platelet transfusions, 6% received one or more (median 1) FP infusions and 2% received cryoprecipitate (median 1 dose). Seventy percent of the erythrocyte transfusions were given in compliance with the guidelines, as were 69% of the platelet transfusions, 65% of the FP transfusions and 94% of the cryoprecipitate administrations. Patients who received large numbers of transfusions were more likely to receive transfusion that violated the guidelines. Forty-five percent of patients who received 1 to 3 transfusions received all transfusions within guidelines. However, only 18% of patients who received 4 to 10 transfusions received all within guidelines. No patient who received >10 transfusions received all within the guidelines. Erythrocyte transfusions given early in the hospital course were likely to be within guidelines; 72% (588/818) in the first 29 days were compliant with guidelines, but compliance fell to 61% (144/237) for transfusions administered after 29 days (P ¼ 0.002). About half of the platelet transfusions given early in the hospital course were in violation of guidelines, but after day 9, 83% of platelet transfusions were compliant with guidelines (P ¼ 0.000). Conclusion:Opportunities exist in our healthcare system to improve compliance with our transfusion guidelines. Such opportunities are greatest among neonates receiving multiple transfusions, among those receiving erythrocyte transfusions late in their NICU course and among those receiving platelet transfusions early in their NICU course.

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Platelet transfusions in the neonatal intensive care unit:factors predicting which patients will require multiple transfusions

Abstract: NICU patients with liver disease or renal insufficiency who receive one platelet transfusion are likely to receive additional transfusions. Therefore, these patients constitute a possible study population for a Phase I/II rTPO trial.

Cited by 109 publications

References 33 publications

Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

Template bleeding times of 240 neonates born at 24 to 41 weeks gestation

Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system

Adherence to NICU transfusion guidelines: data from a multihospital healthcare system

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