Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants.
Academic Article
Overview
abstract
OBJECTIVE: To evaluate if hematologic thresholds for red blood cell (RBC) and platelet transfusions changed over time following publication of new evidence from randomized trials in a multicenter cohort of extremely low birth weight (ELBW) infants. STUDY DESIGN: We analyzed data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatrics (REDS-IV-P) study from April 2019 through December 2023. We compared pre-transfusion hemoglobin and platelet counts closest to each transfusion within 24 hours by year using linear mixed models and used model interaction terms to determine if trends over time differed by postnatal weeks. RESULTS: We evaluated 981 ELBW infants. For trends in RBC transfusion thresholds, 785 infants (80%) received 5182 RBC transfusions, of which 4835 (93%) had a pre-transfusion hemoglobin value. Pre-transfusion hemoglobin declined over time (P<0.0001), with trends differing by postnatal week (interaction P=0.005). The greatest year-over-year decline in pre-transfusion hemoglobin was in the 3rd postnatal week or later. For platelet transfusions, 221 infants (23%) received 934 platelet transfusions, of which 900 (96%) had a corresponding pre-transfusion platelet count. There was no change in pre-transfusion platelet count over time (P=0.24). These trends did not differ by postnatal week (interaction P=0.14), although pre-transfusion platelet counts were lower after the first postnatal week (P<0.001). CONCLUSIONS: In this cohort of US centers, we observed declines in pre-transfusion hemoglobin but not pre-transfusion platelet counts from 2019-2023. These findings suggest evidence from recent RBC and platelet transfusion threshold trials may have been differentially translated into clinical practice for ELBW infants.
