Platelet transfusion efficacy in pregnant women with thrombocytopenia: A retrospective study

Platelet transfusion plays an irreplaceable role in the treatment of thrombocytopenia during pregnancy. We examined the effect of prophylactic platelet transfusions in the prenatal period through retrospective analysis of 106 women with 192 platelet transfusions between 2016 and 2023.

Univariate and multivariable analyses determined the independent risk factors for suboptimal platelet concentrate (PC) transfusion response (corrected count increment [CCI] <7 at 18-24 h after platelet transfusion) and platelet transfusion refractoriness (PTR) (at least two consecutive ABO-matched PC transfusions with a CCI < 7).

Suboptimal platelet transfusion response occurred in 117 of the 192 (60.9%) transfusion episodes, which was independently associated with previous allogeneic PC transfusion and severe thrombocytopenia (<50 × 10⁹/L); 55.4% of transfusion episodes with suboptimal response were found in those women with previous allogeneic PC transfusion and severe thrombocytopenia. In addition, 25 of the 106 (23.6%) women developed PTR, which was independently associated with advanced maternal age (>35 years), previous PC transfusion, low gestational age (<37 weeks), severe thrombocytopenia and immune thrombocytopenia (ITP). Furthermore, women with PTR had longer hospital stays, a greater rate of intensive care unit (ICU) transfer and a slower platelet recovery until 42 days postpartum.

Prophylactic platelet transfusions are often associated with poor efficacy in pregnant women with thrombocytopenia. The findings will contribute to further research on the potential mechanism of PTR to optimize transfusion practices.