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Impact of restrictive platelet transfusion strategies on transfusion rates: A cohort study in very preterm infants.
Heeger, L E; Houben, N A M; Caram-Deelder, C; Fustolo-Gunnink, S F; van der Bom, J G; Lopriore, E.
Afiliação
  • Heeger LE; Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Houben NAM; Sanquin Blood Supply Foundation, Clinical Center for Transfusion Research, Amsterdam, The Netherlands.
  • Caram-Deelder C; Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
  • Fustolo-Gunnink SF; Sanquin Blood Supply Foundation, Clinical Center for Transfusion Research, Amsterdam, The Netherlands.
  • van der Bom JG; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
  • Lopriore E; Sanquin Blood Supply Foundation, Clinical Center for Transfusion Research, Amsterdam, The Netherlands.
Transfusion ; 64(8): 1421-1427, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38660945
ABSTRACT

BACKGROUND:

Evidence supports a restrictive platelet transfusion threshold in preterm neonates. We aimed to describe the effect of implementing this threshold on transfusion rates. STUDY DESIGN AND

METHODS:

This retrospective observational cohort study included all very preterm infants (born <32 weeks' gestation) admitted to a neonatal intensive care unit between 2004 and 2022, divided into three epochs. Platelet transfusion thresholds changed from 30 × 109/L for stable neonates and 50 × 109/L for unstable neonates (January 2004 to December 2009) to 20 × 109/L for stable neonates and 50 × 109/L for unstable neonates (January 2010 to June 2019) to 25 × 109/L for non-bleeding neonates and 50 × 109/L for neonates with major bleeding (July 2019 to July 2022). The primary outcome was the percentage of transfused neonates in each epoch. Secondary outcomes included the median number of transfusions per neonate, the percentage of transfusions given above 25 or 50 × 109/L, and major bleeding and mortality rates.

RESULTS:

The percentage of neonates transfused was 12.2% (115/939), 5.8% (96/1660), and 4.8% (25/525) in Epoch I, II, and III, respectively (p < .001), a relative reduction of 61%. The median number of transfusions per transfused neonate was 2.0 (interquartile range [IQR] 1.0-3.0) in Epoch I, and 1.0 (IQR 1.0-2.0) in subsequent Epochs (p = .04). The percentage of infants receiving at least one transfusion above 50 × 109/L in Epoch I, II, and III was 51.3% (59/115), 17.7% (17/96), and 20.0% (5/25; p < .001). Mortality and bleeding rates did not significantly differ between epochs.

DISCUSSION:

Implementation of restrictive platelet guidelines led to reduction of the rate and number of platelet transfusions.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transfusão de Plaquetas Limite: Female / Humans / Male / Newborn Idioma: En Revista: Transfusion Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Transfusão de Plaquetas Limite: Female / Humans / Male / Newborn Idioma: En Revista: Transfusion Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Holanda País de publicação: Estados Unidos