Nellis, ME;
Karam, O;
Mauer, E;
Cushing, MM;
Davis, PJ;
Steiner, ME;
Tucci, M;
... Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) ne; + view all
(2018)
Platelet Transfusion Practices in Critically Ill Children.
Critical Care Medicine
, 46
(8)
pp. 1309-1317.
10.1097/CCM.0000000000003192.
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Abstract
Rationale: The epidemiology, indications, and outcomes for critically ill children transfused red blood cells or plasma have been described recently in large multicenter studies. This information is not known regarding platelet transfusions in this population. Objectives: To describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Methods: This point-prevalence study was conducted in 82 pediatric intensive care units in 16 countries during six assigned weeks. All children included received a platelet transfusion prescribed during one of the screening days. Measurements and Main Results: During six weeks of screening, 16,934 patients were eligible, of whom 559 received at least one platelet transfusion (prevalence 3.3%). The indications for transfusion included prophylaxis in 67%, minor bleeding in 21% and major bleeding in 12%. Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was ≥ 50 x 109 cells/L. The median (IQR) change in platelet count was 48 x 109 cells/L (17-82) for major bleeding, 42 x 109 cells/L (16-80) for prophylactic transfusions, 38 x 109 cells/L (17-72) for minor bleeding, and 25 x 109 cells/L (10-47) for prophylaxis in patients at risk of bleeding from a device. Overall mortality for all patients was 25%. Conclusions: The majority of platelet transfusions prescribed are given as prophylaxis to non-bleeding children and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with a particular focus on prophylactic transfusions.
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