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Updated: Sep 15, 2025
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Assessing the Efficacy of Pathogen-Reduced Platelet Transfusions for Hemostasis in Children Undergoing
Sophia Hsien1, Samuel Reinert2, Jacob Shamash3
1Division of Pediatric Cardiology, Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, New York.
Insights
Pathogen-reduced (PR) platelets provide adequate hemostasis in pediatric cardiopulmonary bypass (CPB) surgery patients, showing similar chest tube bleeding and transfusion rates compared to large-volume delayed sampling (LVDS) platelets, with added microbial safety benefits.
Area of Science:
- Pediatric Cardiac Surgery
- Transfusion Medicine
- Hemostasis and Thrombosis
Background:
- Children undergoing cardiopulmonary bypass (CPB) surgery face high bleeding risks, often necessitating transfusions.
- Pathogen-reduced (PR) platelets offer reduced microbial contamination but raise concerns about efficacy.
- Previous studies suggest PR platelets may lead to lower platelet count increments and increased transfusion requirements.
Purpose of the Study:
- To compare the hemostatic effectiveness of PR platelets versus large-volume delayed sampling (LVDS) platelets in pediatric CPB surgery.
- To evaluate postoperative bleeding and transfusion needs in children receiving these different platelet types.
Main Methods:
- Retrospective review of pediatric patients undergoing CPB surgery between 2020-2022.
- Comparison of demographics, operative details, transfusion data, and outcomes between PR and LVDS platelet groups.
- Primary outcome measured was 24-hour postoperative chest tube bleeding.
Main Results:
- No significant differences were observed in postoperative chest tube bleeding between PR and LVDS platelet groups at any time point (1, 2, 4, 8, 12, and 24 hours).
- Rates of red blood cell, plasma, and cryoprecipitate transfusions were also comparable between the two groups.
- Patient demographics and surgical risk scores were similar across both treatment arms.
Conclusions:
- PR platelets demonstrated equivalent hemostatic performance to LVDS platelets in pediatric CPB surgery.
- The use of PR platelets did not result in increased chest tube bleeding or transfusion requirements.
- PR platelets offer a potentially safer alternative due to reduced microbial contamination without compromising hemostasis.
Background:
Children undergoing cardiopulmonary bypass (CPB) surgery are vulnerable to bleeding and often require transfusions. Pathogen-reduced (PR) platelets may reduce microbial contamination but are associated with decreased platelet count increments and increased transfusions. We sought to evaluate hemostasis in children undergoing CPB surgery receiving PR platelets vs large-volume delayed sampling (LVDS) platelets.
Methods:
We performed a retrospective review of children in a cardiac intensive care unit after CPB surgery from 2020 to 2022. Demographics, operative characteristics, transfusion details, and outcomes were compared. The primary outcome was postoperative chest tube bleeding in the first 24 hours.
Results:
There were 522 patients enrolled; 47% (243/522) received LVDS platelets and 53% (279/522) received PR platelets. Median (interquartile range) age was 4 (0-29) months. There were no differences in age (P = .499) or The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery congenital heart surgery mortality score (P = .813). There were no differences between platelet groups in postoperative chest tube bleeding at 1 hour (2.9 vs 3.2 mL/kg; P = .179), 2 hours (4.9 vs 5.1 mL/kg; P = .368), 4 hours (7.7 vs 8.1 mL/kg; P = .433), 8 hours (11.9 vs 12.9 mL/kg; P = .610), 12 hours (17.0 vs 17.1 mL/kg; P = .966), or 24 hours (28.0 vs 27.0 mL/kg; P = .536) after surgery. There were also no differences in doses of red blood cells (P = .054), cell salvage (P = .220), plasma (P = .337), or cryoprecipitate (P = .091).
Conclusions:
Children who received PR platelets had the same amount of chest tube output and did not require increased transfusions compared with LVDS platelet recipients. In children undergoing CPB surgery, PR platelets appeared to provide adequate hemostasis with further theoretical benefit of reduced microbial contamination.
