Platelet Transfusion Practices and Outcomes in Neonates and Children.

Area of Science:

• Pediatric Hematology
• Transfusion Medicine
• Clinical Epidemiology

Background:

• Platelet transfusions are vital for neonates and children at risk of bleeding.
• Understanding factors influencing transfusion effectiveness and burden is crucial for optimizing pediatric care.

Purpose of the Study:

• To analyze the epidemiology of platelet transfusions in pediatric patients.
• To determine associations between donor and platelet characteristics and posttransfusion outcomes, including platelet increments and transfusion burden.

Main Methods:

• A retrospective, multicenter cohort study utilizing a donor-component-recipient linked database.
• Included patients <18 years old from April 2019 to June 2023.
• Analyzed data on platelet transfusion frequency, dosage, pretransfusion counts, and associations with product characteristics (e.g., pathogen reduction, additive solutions, storage duration) and donor factors (sex, age).

Main Results:

• Platelet transfusions were administered in 3.6% of inpatient encounters, with variations by age group.
• Pathogen reduction (PR), platelet additive solutions (PAS), longer storage (>3 days), male donors, and older donor age (>40 years) were linked to lower posttransfusion platelet increments.
• Use of PR, PAS, longer storage, and older donor age correlated with a higher rate of subsequent transfusions, but not with hospital length of stay or mortality.

Conclusions:

• Most pediatric transfusions, excluding those for active bleeding, occurred at high pretransfusion platelet counts.
• Specific transfusion components and donor characteristics influence platelet increments and transfusion burden in children.
• Findings suggest areas for optimizing transfusion strategies in pediatric populations, warranting further prospective validation.