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Routine Screening Method for Microparticles in Platelet Transfusions
Published on: January 31, 2018
Platelet transfusion in neonatal intensive care units of 22 European countries: a prospective observational study
Nina A M Houben1,2, Enrico Lopriore2, Karin Fijnvandraat3,4
1Sanquin Research, Sanquin Blood Supply Foundation, Amsterdam, the Netherlands.
Insights
European neonates with severe thrombocytopenia are increasingly receiving prophylactic platelet transfusions at a lower threshold of 25 × 10⁹/L. However, significant practice variations persist, necessitating further research into optimal transfusion protocols.
Area of Science:
- Neonatal Medicine
- Hematology
- Clinical Practice Research
Background:
- Platelet transfusions are administered to preterm infants with severe thrombocytopenia to prevent hemorrhage.
- The PlaNeT2/MATISSE trial indicated higher mortality/bleeding risks with a 50 × 10⁹/L threshold compared to 25 × 10⁹/L.
- Current adoption of these findings in European clinical practice remains unclear.
Purpose of the Study:
- To investigate current neonatal platelet transfusion practices across Europe.
- To assess the integration of evidence-based transfusion thresholds into clinical settings.
- To identify variations in transfusion indications, volumes, and rates.
Main Methods:
- A prospective observational study was conducted in 64 NICUs across 22 European countries (Sept 2022 - Aug 2023).
- Data collected included transfusion prevalence, cumulative incidence by day 28, indications, volumes, rates, platelet count triggers, and adverse effects.
- Statistical analyses involved random effects Poisson and logistic regression models.
Main Results:
- 71 out of 1143 (6.2%) preterm infants received 217 transfusions.
- The cumulative incidence of transfusion by day 28 was 8.3% (95% CI: 5.5-11.1).
- Most transfusions (74.2%) were indicated for threshold, with 33.1% of pre-transfusion counts exceeding 25 × 10⁹/L; significant variability in volume and duration was observed.
Conclusions:
- The restrictive platelet transfusion threshold of 25 × 10⁹/L is being adopted in European clinical practice.
- Substantial variation exists in transfusion practices, highlighting the need for further research.
- Evidence generation is required for optimal transfusion volumes and infusion rates in neonates.
Background:
Platelet transfusions are given to preterm infants with severe thrombocytopenia aiming to prevent haemorrhage. The PlaNeT2/MATISSE trial revealed higher rates of mortality and/or major bleeding in preterm infants receiving prophylactic platelet transfusions at a platelet count threshold of 50 × 109/L compared to 25 × 109/L. The extent to which this evidence has been incorporated into clinical practice is unknown, thus we aimed to describe current neonatal platelet transfusion practices in Europe.
Methods:
We performed a prospective observational study in 64 neonatal intensive care units across 22 European countries between September 2022 and August 2023. Outcome measures included observed transfusion prevalence rates (per country and overall, pooled using a random effects Poisson model), expected rates based on patient-mix (per country, estimated using logistic regression), cumulative incidence of receiving a transfusion by day 28 (with death and discharge considered as competing events), transfusion indications, volumes and infusion rates, platelet count triggers and increment, and adverse effects.
Findings:
We included 1143 preterm infants, of whom 71 (6.2%, [71/1143]) collectively received 217 transfusions. Overall observed prevalence rate was 0.3 platelet transfusion days per 100 admission days. By day 28, 8.3% (95% CI: 5.5-11.1) of infants received a transfusion. Most transfusions were indicated for threshold (74.2%, [161/217]). Pre-transfusion platelet counts were above 25 × 109/L in 33.1% [53/160] of these transfusions. There was significant variability in volume and duration.
Interpretation:
The restrictive threshold of 25 × 109/L is being integrated into clinical practice. Research is needed to explore existing variation and generate evidence for various aspects including optimal volumes and infusion rates.
Funding:
Sanquin, EBA, and ESPR.
