Assessing the Efficacy of Pathogen-Reduced Platelet Transfusions for Hemostasis in Children Undergoing Cardiopulmonary Bypass Surgery.
Academic Article
Overview
abstract
BACKGROUND: Children undergoing cardiopulmonary bypass (CPB) surgery are vulnerable to bleeding and often require transfusions. Pathogen-reduced platelets may reduce microbial contamination but are associated with decreased platelet count increments and increased transfusions. We sought to evaluate hemostasis in children undergoing CPB surgery receiving pathogen-reduced platelets versus large-volume delayed sampling (LVDS) platelets. METHODS: We performed a retrospective review of children in a cardiac intensive care unit following CPB surgery from 2020-2022. Demographics, operative characteristics, transfusion details, and outcomes were compared. The primary outcome was post-operative chest tube bleeding in the first 24 hours. RESULTS: 522 patients were enrolled. Forty-seven percent (243/522) received LVDS platelets and 53% (279/522) received pathogen-reduced platelets. Median (IQR) age was 4 (0-29) months. There were no differences in age (p=0.499) or STAT score (p=0.813). There were no differences between platelet groups in post-operative chest tube bleeding at 1 hour (2.9 vs 3.2 mL/kg, p=0.179), 2 hours (4.9 vs 5.1 mL/kg, p=0.368), 4 hours (7.7 vs 8.1 mL/kg, p=0.433), 8 hours (11.9 vs 12.9 mL/kg, p=0.610), 12 hours (17.0 vs 17.1 mL/kg, p=0.966), or 24 hours (28.0 vs 27.0 mL/kg, p=0.536) after surgery. There were also no differences in doses of red blood cells (p=0.054), cell saver (p=0.220), plasma (p=0.337), or cryoprecipitate (p=0.091). CONCLUSIONS: Children who received pathogen-reduced platelets had the same amount of chest tube output and did not require increased transfusions compared to LVDS platelet recipients. In children undergoing CPB surgery, pathogen-reduced platelets appeared to provide adequate hemostasis with further theoretical benefit of reduced microbial contamination.
