Current red blood cell and platelet transfusion practices in Canadian neonatal intensive care units

Red blood cell and platelet transfusions are often prescribed in preterm infants. Consensus on the best transfusion practices in this population has still not been reached, causing disparities in neonatal care. The objective of this study is to provide updated data on current red blood cell and platelet transfusion practices in preterm neonates regarding thresholds and justifications associated with the decision to transfuse.

An electronic survey was sent to one neonatology representative of each center of the Canadian Neonatal Network (31 sites). Descriptive data from each center was collected from the Network's work database.

More than half of the respondents (54.8%) have a red blood cell transfusion protocol, while only 32.3% of centers have a platelet transfusion protocol. The most commonly reported justification for red blood cell transfusion is low levels of hemoglobin (100%), while the severity of illness and hemodynamic instability were also frequently mentioned (58.1% and 35.5%). For platelet transfusion justifications, the most reported is low platelet count (96.8%), followed by significant bleeding (93.6%) and severity of illness (35.5%). The reported thresholds also vary greatly depending on the presence of oxygen support for red blood cell transfusions and the occurrence of bleeding or invasive procedures for platelets.

There is great variability between Canadian centers concerning red blood cells and platelet transfusions in preterm neonates. Practice guidelines should be established for better oversight of transfusion practices in preterm infants to support more judicious use of blood products.