An improvement project standardizing low prophylactic platelet transfusion dosing for infants

Area of Science:

• Neonatal Medicine
• Hematology
• Pediatric Critical Care

Background:

• Platelet transfusions are common for preterm infants but current practices may be harmful.
• Randomized trials indicate adverse effects associated with existing transfusion protocols.
• High transfusion volumes (15-20 mL/kg) were frequently administered.

Purpose of the Study:

• To reduce platelet exposure in neonates.
• To implement standardized 10 mL/kg platelet transfusions for non-bleeding thrombocytopenic infants.
• To improve platelet transfusion practices in a level IV Neonatal Intensive Care Unit (NICU).

Main Methods:

• Developed evidence-based platelet dosing guidelines.
• Implemented changes through three plan-do-study-act cycles.
• Focused on education, reinforcement, and electronic clinical decision support.

Main Results:

• Achieved 100% adherence to 10 mL/kg transfusions, up from 17.6%.
• No increase in major bleeding or repeat transfusion rates observed.
• Reduced monthly transfused platelet volumes significantly (2269±334 mL to 857±181 mL).
• Resulted in monthly cost savings of $2746-$4942.

Conclusions:

• Successfully improved platelet transfusion practices in neonates.
• Demonstrated feasibility of guideline adoption for other institutions.
• Facilitated conservation of limited platelet resources and cost savings.