Platelet Transfusion Practices and Outcomes in Neonates and Children.

Overview

abstract

IMPORTANCE: Platelet transfusions are critical interventions for neonates and children who are at risk of or who are experiencing bleeding. OBJECTIVE: To describe the epidemiology of platelet transfusions and associations of blood donor and platelet characteristics with posttransfusion platelet increments, transfusion burden, and clinical outcomes in neonates and children. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included patients younger than 18 years of age (with birth weights higher than 2500 g) between April 1, 2019, and June 30, 2023, from the Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric Vein-to-Vein multicenter, retrospective, donor-component-recipient-linked database. Neonates were considered individuals less than 28 days of age; otherwise, participants were considered older children. EXPOSURE: Platelet transfusion. MAIN OUTCOME AND MEASURES: The main outcomes were posttransfusion platelet increments and subsequent transfusion burden associated with platelet processing and donor characteristics. RESULTS: Of 249 340 inpatient encounters, platelet transfusion was reported in 8874 (3.6%) patients (4934 of 131 592 encounters [3.7%] male; median [IQR] age 2.5 [0.6-11.2] years). Platelet transfusion was lowest among children younger than 1 year of age (2.6%) and highest among children 1 to less than 6 years of age (4.7%; P < .001). The median (IQR) dose was 14.9 mL/kg for neonates and 9.6 mL/kg for older children. After excluding patients with bleeding, most transfusions in neonates (67.8%) and older children (81.0%) were performed at pretransfusion platelet counts greater than 25 × 103/µL and greater than 10 × 103/µL, respectively. Median (IQR) pretransfusion platelet counts in neonates (34 × 103/µL [20-54 × 103/µL]) were significantly higher than in older children (22 × 103/µL [11-40 × 103/µL]; P < .001). Pathogen reduction (PR) (adjusted odds ratio [AOR], 0.82 [95% CI, 0.73-0.92]), use of platelet additive solution (PAS) (AOR, 0.32 [95% CI, 0.27-0.37]), platelet storage duration longer than 3 days (AORs ranged from 0.67 [95% CI, 0.58-0.76] to 0.82 [95% CI, 0.76-0.88]), male sex (AOR, 0.92 [95% CI, 0.86-0.98]), and donor age 40 years or older (AOR, 0.79 [95% CI, 0.72-0.86]) were associated with lower platelet increments (all P < .001). Use of PR platelets (adjusted rate ratio [ARR], 1.05 [95% CI, 1.02-1.07), use of PAS (ARR, 1.44 [95% CI, 1.40-1.47]), storage duration longer than 3 days (ARR, 1.11 [95% CI, 1.09-1.13] for 4 to <5 days and ARR, 1.28 [95% CI, 1.26-1.30] for ≥5 days), and donor age of 40 years or older (ARR, 1.15 [95% CI, 1.13-1.17] for 40 to <60 years and ARR, 1.10 [95% CI, 1.08-1.12] for ≥60 years) on the first transfusion were associated with a significantly higher rate of receiving a subsequent transfusion. These factors were not associated with hospital length of stay or mortality. CONCLUSIONS AND RELEVANCE: In this multicenter, donor-product-recipient linked cohort study, after excluding patients with bleeding, most transfusions among neonates and older children were at high pretransfusion platelet counts. Use of PAS, PR, longer storage duration, male donors, and donor age older than 40 years were independently associated with lower posttransfusion platelet increments. Use of PAS, PR, platelet storage longer than 3 days, and donor age 40 years or older were associated with a significantly higher overall platelet transfusion burden but were not associated with hospital length of stay or mortality. These results have important implications for transfusion practices for platelets among neonates and children and need validation in well-designed prospective studies.