Transfusion guidelines for neonates and older children

Gibson, Brenda; Todd, Alexander D.; Roberts, Irene; Pamphilon, Derwood; Rodeck, Charles; Bolton‐Maggs, Paula; Burbin, Geoff; Duguid, J. K. M.; Boulton, Frank; Cohen, Hannah; Smith, Neil R.; McClelland, D. B. L.; Rowley, Megan; Turner, Graeme L

doi:10.1111/j.1365-2141.2004.04815.x

Cited by 309 publications

(38 citation statements)

References 107 publications

(125 reference statements)

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“…The justification for selection of lower and higher platelet count thresholds at 25 × 10 9 /l and 50 × 10 9 /l for this trial is based on current national guidance [5], a prospective observational study of platelet transfusion practice (PlaNeT-1) [12], a UK survey of practice [4] and the recognition that in the only randomised controlled trial to assess a threshold level for the effectiveness of neonatal prophylactic platelet transfusions, the lower platelet count threshold was 50 × 10 9 /l [8]. …”

Section: Summary Of Studymentioning

confidence: 99%

“…Despite the frequency of administration, policies and protocols for neonatal platelet transfusion therapy vary widely between clinicians and institutions [4]. Recommendations in national guidelines are based largely on consensus rather than evidence [5,6,7], and are often extrapolated from adult data. The only randomised controlled trial to assess a threshold level for the effectiveness of neonatal prophylactic platelet transfusions looked at moderate thrombocytopenia (defined as 50-150 × 10 9 /l) and found allowing platelets to drop below 150 × 10 9 /l was not detrimental to short-term neonatal outcome [8].…”

Section: Introductionmentioning

confidence: 99%

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Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

et al. 2014

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Introduction: Neonatal thrombocytopenia is a common and important clinical problem in preterm neonates. A trial assessing clinically relevant outcomes in relation to the different platelet count thresholds used to trigger transfusion has never been undertaken in preterm neonates with severe thrombocytopenia. Objectives: Platelets for Neonatal Transfusion - Study 2 (PlaNeT-2) aims to assess whether a higher prophylactic platelet transfusion threshold is superior to the lower thresholds in current standard practice in reducing the proportion of patients who have a major bleed or die up to study day 28. Methods: PlaNeT-2 is a two-stage, randomised, parallel-group, superiority trial. PlaNet-2 compares clinical outcomes in preterm neonates (<34 weeks' gestation at birth) randomised to receive prophylactic platelet transfusions to maintain platelet counts at or above either 25 × 10⁹/l or 50 × 10⁹/l. The primary outcome measure is the proportion of patients who either die or experience a major bleed up to and including study day 28. A total of 660 infants will be randomised. Results and Conclusions: This trial will help define optimal platelet transfusion support for severely thrombocytopenic preterm neonates by evaluating the risks and benefits of two different prophylactic neonatal platelet transfusion thresholds.

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Section: Summary Of Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

et al. 2014

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“…To reduce the risk of hemorrhage and neurological complications the British Committee for Standards in Hematology recommends the use of prophylactic platelet transfusions if the platelet count is less than 40,000 per microliter in children [18] and if less than 50,000 per microliter in adults [5]. Spinal hemorrhage is rare and in both guidelines it is acknowledged that there is a lack of evidence to support the recommendations.…”

Section: Discussionmentioning

confidence: 99%

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Liu¹,

Li²,

Wang³

2012

OJAnes

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Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in preeclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as "safe" for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.

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“…We included all actively bleeding and post-surgical patients irrespective of hemodynamic stability. The British Society of Hematology [22] also suggested a postoperative hemoglobin level of 7 g/dl as transfusion threshold in both children and adults with stable postoperative cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin Threshold for Blood Transfusion in a Pediatric Intensive Care Unit

Chegondi

Sasaki

Raszynski

et al. 2015

Transfus Med Hemother

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Objective: To evaluate the hemoglobin threshold for red cell transfusion in children admitted to a pediatric intensive care unit (PICU). Methods: Retrospective chart review study. Tertiary care PICU. Critically ill pediatric patients requiring blood transfusion. No intervention. Results: We analyzed the charts of all children between 1 month and 21 years of age who received packed red blood cell (PRBC) transfusions during a 2-year period. The target patients were identified from our blood bank database. For analysis, the patients were subdivided into four groups: acute blood loss (postsurgically, trauma, or acute gastrointestinal bleeding from other causes), hematologic (hematologic malignancies, bone marrow suppression, hemolytic anemia, or sickle cell disease), unstable (FiO₂ > 0.6 and/or on inotropic support), and stable groups. We also compared the pre-transfusion hemoglobin threshold in all unstable patients with that of all stable patients. A total of 571 transfusion episodes in 284 patients were analyzed. 28% (n = 160) of transfusions were administered to patients in the acute blood loss group, 36% (n = 206) to hematologic patients, 17% (n = 99) to unstable patients, and 18% (n = 106) to stable patients. The mean pre-transfusion hemoglobin (± SD) in all children as well as in the acute blood loss, hematologic, unstable and stable groups was 7.3 ± 1.20, 7.83 ± 1.32, 6.97 ± 1.31, 7.96 ± 1.37, 7.31 ± 1.09 g/dl, respectively. The transfusion threshold for acute blood loss and unstable groups was higher compared to hematologic and stable groups (p < 0.001; ANOVA with multiple comparisons). The mean pre-transfusion hemoglobin threshold for stable and unstable patients among all groups was 7.3 ± 1.3 and 7.9 ± 1.3 (p < 0.0001), respectively. The observed mortality rate was higher among children who received transfusion compared to other children admitted to PICU. Conclusion: The hemoglobin threshold for transfusion varied according to clinical conditions. Overall, the hemoglobin threshold for transfusion was 7.3 ± 1.20 g/dl.

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Transfusion guidelines for neonates and older children

Cited by 309 publications

References 107 publications

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Platelets for Neonatal Transfusion - Study 2: A Randomised Controlled Trial to Compare Two Different Platelet Count Thresholds for Prophylactic Platelet Transfusion to Preterm Neonates

Uneventful Spinal Anesthesia in a Patient with Precipitous Drop of Platelet Secondary to HELLP Syndrome: A Case Report and Review of Literatures

Hemoglobin Threshold for Blood Transfusion in a Pediatric Intensive Care Unit

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