Responsiveness to Platelet Transfusions in Pediatric Patients with Thrombocytopenia: Incidence, Clinical Variables

Refractoriness to platelet transfusion has not been adequately studied in pediatric patients with thrombocytopenia. Our objectives were: (1) to describe the practice of platelet transfusion in pediatric patients with thrombocytopenia of various etiologies; (2) to assess the responsiveness to platelet transfusions and clinical variables affecting platelet transfusions response; and (3) to evaluate incidence of PTR.

A retrospective study included pediatric patients with thrombocytopenia admitted to a tertiary children's hospital who received ≥ 1 platelet transfusion during hospitalization. Responsiveness was measured by corrected count increment (CCI), poor platelet transfusion response (PPTR), and platelet transfusion refractoriness (PTR).

A total of 334 patients were eligible for the study and received 1,164 transfusions, with a median of 2 (IQR: 1 - 5) platelet transfusions. Patients admitted with hematologic malignancies had the highest median number of platelet transfusions (5, IQR: 4 - 10). The median CCI of 1,164 platelet post-transfusions was 17.0 (IQR: 9.4 - 24.6) and the incidence of PPTR was 11.9%. Patients admitted with ITP had the lowest median CCI (7.6, IQR: 1.0 - 12.5) and the highest incidence of PPTR (36.4%, 8/22). Older age of platelet components, low doses of platelet transfusion, increasing number of platelet transfusions (≥ 5), splenomegaly, bleeding, DIC, shock, ECMO supported, and HLA antibody-positive were independent risk factors for PPTR. Finally, the incidence of PTR was 11.4%.

Practical experience of clinicians regarding the use of apheresis platelets in pediatric patients is determined. Highlight that PTR is not a low probability event when apheresis platelets are received in pediatric patients.