Posttransfusion platelet increments after different platelet products in neonates: a retrospective cohort study

In the Netherlands different platelet (PLT) products are used for neonatal transfusions: volume-reduced PLTs, PLT additive solution (PAS) II PLTs, and plasma PLTs. These are standard products at three different neonatal intensive care units where local transfusion guidelines apply. Here we assess the posttransfusion count increments with these products.

We performed a retrospective cohort study of neonates who received, in the first month after birth, between January 1, 2007, and December 31, 2008, at least one PLT transfusion. Seventy-four neonates who received 197 volume-reduced PLTs transfusions, 68 neonates who received 105 PASII PLT transfusions, and eight neonates who received eight plasma PLT transfusions were analyzed. Early (within 8 hr after transfusion) and follow-up count increments (16-24 hr after transfusion) were evaluated for 191 and 81 volume-reduced PLTs, 77 and 56 PASII PLTs, and six and five plasma PLT transfusions, respectively, using a random-effects model.

Volume-reduced PLTs were transfused at twice the dose in one-fifth the volume of PASII and plasma PLTs. The early posttransfusion count increment was higher for volume-reduced PLTs at 111 × 10(9)/L (95% confidence interval [CI], 86-135) compared to PASII PLTs at 62 × 10(9)/L (95% CI, 40-84; p = 0.000) and plasma PLTs at 47 × 10(9)/L (95% CI, 14-79). The follow-up count increment was also higher for volume-reduced PLTs at 60 × 10(9)/L (95% CI, 19-100) compared to PASII PLTs at 38 × 10(9)/L (95% CI, -0.2 to 77; p = 0.082) and plasma PLTs at 4 × 10(9)/L (95% CI, -38 to 46).

Neonates who received twice the PLT dose by volume-reduced PLTs had twice as high early and follow-up count increment showing similar efficacy of products.