Platelet Transfusion Practices for Critically Ill Children: A 28-Day Point-Prevalence Study in Three European...

Area of Science:

• Pediatric Critical Care Medicine
• Hematology
• Transfusion Medicine

Background:

• Platelet transfusions are a cornerstone therapy for critically ill children.
• Understanding current transfusion practices, indications, and outcomes is crucial for optimizing patient care.
• Variability in transfusion thresholds and triggers necessitates further investigation.

Purpose of the Study:

• To determine the prevalence, indications, and thresholds for platelet transfusions in European pediatric intensive care units (PICUs).
• To analyze the outcomes, including mortality, associated with platelet transfusions in critically ill children.
• To evaluate the effectiveness of current transfusion practices and identify areas for improvement.

Main Methods:

• International 4-week point-prevalence study conducted in 2023 across 44 PICUs in Spain, the UK, and Italy.
• Included 2713 pediatric patients (1 month to 17 years) receiving platelet transfusions.
• Data collected on transfusion indications, pre- and post-transfusion platelet counts, and 28-day mortality.

Main Results:

• 4.1% of patients received platelet transfusions, with low platelet count (54%) and prophylactic indications (83%) being primary reasons.
• Median pretransfusion platelet count was 36×10^9 cells/L, varying significantly by diagnosis.
• 28-day PICU mortality was 21.8%, with higher transfusion rates and doses associated with increased mortality.

Conclusions:

• Platelet transfusions are frequently administered for low platelet counts, often prophylactically, with considerable variability in practice.
• Current transfusion practices may exceed recommended thresholds, and outcomes suggest an association with mortality.
• Further pediatric trials are needed to establish optimal platelet transfusion thresholds and triggers in critically ill children.