Risk factors of platelet refractoriness in children

Abstract

Therapeutic platelet transfusions are often performed in pediatric patients with various indications. However, the platelet transfusion has potentially induced more harm than good for some patients. Therefore, its effectiveness needs to be evaluated. This study aimed to evaluate the clinical risk factors namely sepsis, splenomegaly, DIC (disseminated intravascular coagulation), severe bleeding and the history of platelet transfusion in the incidence of platelet refractoriness. This was a casecontrol study conducted over a 13-month period from August 1 st , 2010 until September 30 th , 2011 in Department of Pediatrics, Dr. Sardjito General Hospital, Yogyakarta. From a total of 1403 platelet transfusion episodes in 464 patients, 86 incidences of refractoriness and 86 of nonrefractoriness were observed. Bivariate analysis showed that sepsis [OR= 5.91 (2.90-12.05); p = 0.000], splenomegaly [OR= 2.82 (1.32-6.04); p = 0.006], severe bleeding [OR= 8.41 (4.19-16.871); p = 0.000], DIC [OR = 22.96 (6.73-78.35); p = 0.000] and the history of platelet transfusions [OR= 5.33 (2.78-10.23); p = 0.000] increased the risk of platelets refractoriness. Furthermore, multivariate analysis showed that sepsis (OR= 2.96; 95%CI: 1.19-7.32; p = 0.019), splenomegaly (OR=3.94; 95% CI: 2.21-16.00; p = 0.000), severe bleeding (OR = 3.53; 95% CI : 1.40-8.89; p = 0.008), DIC (OR = 5.54; 95% CI: 1.29-22.75; p = 0.021) and the history of platelet transfusion (OR = 2.84; 95% CI: 2.74-9.77; p = 0.001) were the independent risk factors for the occurrence of platelet refractoriness. In conclusion, sepsis, splenomegaly, severe bleeding, DIC, and the history of platelet transfusion are the risk factors of platelet refractoriness in pediatric patients.

Risk factors of platelet refractoriness after thrombocyte concentrate transfusion in pediatric acute leukemia

“…All subjects with sepsis experienced platelet refractory but the bivariate analysis shown no significant difference between sepsis and platelet refractory after platelet concentrate transfusion. This is different from the study of Purba et al which stated that sepsis is an independent risk factor for platelet refractory in children with an OR of 2.96 (Purba et al, 2013). These can occur due to differences in the structure of bacteria that cause sepsis such as lipopolysaccharides and endotoxins that also activate platelets directly (Levi, 2005).…”

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

“…The incidence is assumed to be lower, as children are less likely than adults to have been sensitized to platelets by blood transfusions and pregnancy 25 . Limited studies have been published on pediatric PTR, with the majority published over 10 years ago 14–19 . It is challenging to compare the pediatric PTR results from the current study to those previously reported for a number of reasons.…”

“…25 Limited studies have been published on pediatric PTR, with the majority published over 10 years ago. [14][15][16][17][18][19] It is challenging to compare the pediatric PTR results from the current study to those previously reported for a number of reasons. First, different definitions were used for PTR, with some including HLA testing and others not.…”

“…13 Experts suggest that PTR occurs less frequently in children when compared to adults due to decreased exposure to transfusions and pregnancy. To date, few studies have assessed PTR in pediatric oncology patients [14][15][16][17][18][19] ; most studies were published prior to the institution of RBC leukoreduction (LKR), and hence rates of PTR are not comparable to the post-LKR era.…”

“…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).…”