Evaluation of therapeutic and prophylactic platelet transfusion practices in a neonatal intensive care unit

Aim: To investigate the causes of thrombocytopenia requiring platelet transfusion (PT), clinical factors influencing the decision to give PT, and the frequency of major hemorrhage post-PT in a neonatal intensive care unit (NICU). Material and Methods: This retrospective cross-sectional study included neonates who underwent PT at least once in the NICU during a 4-month period. Demographic characteristics, postnatal age at time of PT, number of PTs, thrombocytopenia etiology, and occurrence of major hemorrhage were analyzed. PT threshold was <20x103/μL in group 1; 20x103/μL – 49x103/μL in group 2; and >503/μL in group 3. Results: Thirty-seven (4.9%) of the 751 patients admitted to the NICU during the study period received PT. These 37 patients received a total of 133 PTs. The most common etiology of thrombocytopenia requiring PT was sepsis (83.5%), followed by NEC (9.8%). Of the 133 PTs, 7 were administered for early-onset thrombocytopenia and 126 for late-onset thrombocytopenia. All patients in group 1 (n=56) had severe thrombocytopenia only with no additional morbidity; patients in group 2 (n=72) had thrombocytopenia accompanied by severe morbidity and/or major hemorrhage, coagulopathy, or extremely low birth weight (ELBW); patients in group 3 (n=4) received PT due to thrombocytopenia and preoperative preparation, coagulopathy, or major hemorrhage. Seven of the 133 PTs (5.3%) were therapeutic and the other 126 (94.7%) were prophylactic. Existing major hemorrhage persisted after 6 of the 7 therapeutic PTs. Major hemorrhage occurred after only 1 prophylactic PT. Conclusion: It was identified bacterial sepsis and NEC as the two most common clinical indications for PT. In general, prophylactic PT was not followed by major hemorrhage, whereas recurrent major hemorrhage occurred after therapeutic PT. Therefore, randomized controlled studies are needed to determine a safe PT threshold value based on a scoring system for predicting the risk of major hemorrhage.

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