Platelet Transfusion Practices in Critically Ill Children

on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet), The PT Investigators

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Design: Prospective cohort study. Setting: Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. Patients: Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. Interventions: None. Measurements and Main Results: Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 109 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 109 cells/L (17-82 × 109 cells/L) for major bleeding, 42 × 109 cells/L (16-80 × 109 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 109 cells/L (17-72 × 109 cells/L) for minor bleeding, and 25 × 109 cells/L (10-47 × 109 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002; 95% CI, 1.001-1.003; p = 0.005). Conclusions: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.

Original languageEnglish (US)
Pages (from-to)1309-1317
Number of pages9
JournalCritical care medicine
Volume46
Issue number8
DOIs
StatePublished - Jan 1 2018

Fingerprint

Platelet Transfusion
Critical Illness
Hemorrhage
Blood Platelets
Platelet Count
Mortality
Epidemiology
Cohort Studies
Odds Ratio
Prospective Studies
Pediatrics
Equipment and Supplies

Keywords

  • Critical care
  • Pediatrics
  • Platelet transfusions
  • Thrombocytopenia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet), & The PT Investigators (2018). Platelet Transfusion Practices in Critically Ill Children. Critical care medicine, 46(8), 1309-1317. https://doi.org/10.1097/CCM.0000000000003192

Platelet Transfusion Practices in Critically Ill Children. / on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet); The PT Investigators.

In: Critical care medicine, Vol. 46, No. 8, 01.01.2018, p. 1309-1317.

Research output: Contribution to journalArticle

on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet) & The PT Investigators 2018, 'Platelet Transfusion Practices in Critically Ill Children', Critical care medicine, vol. 46, no. 8, pp. 1309-1317. https://doi.org/10.1097/CCM.0000000000003192
on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet), The PT Investigators. Platelet Transfusion Practices in Critically Ill Children. Critical care medicine. 2018 Jan 1;46(8):1309-1317. https://doi.org/10.1097/CCM.0000000000003192
on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet) ; The PT Investigators. / Platelet Transfusion Practices in Critically Ill Children. In: Critical care medicine. 2018 ; Vol. 46, No. 8. pp. 1309-1317.
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T1 - Platelet Transfusion Practices in Critically Ill Children

AU - on behalf of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet)

AU - The PT Investigators

AU - Nellis, Marianne E.

AU - Karam, Oliver

AU - Mauer, Elizabeth

AU - Cushing, Melissa M.

AU - Davis, Peter J.

AU - Steiner, Marie E.

AU - Tucci, Marisa

AU - Stanworth, Simon J.

AU - Spinella, Philip C.

AU - Butt, Warwick

AU - Delzoppo, Carmel

AU - Erickson, Simon

AU - Croston, Elizabeth

AU - Barr, Samantha

AU - Cavazzoni, Elena

AU - de Jaeger, Annick

AU - French, Mary Ellen

AU - Ropars, Marion

AU - Clayton, Lucy

AU - Murthy, Srinivas

AU - Krahn, Gordon

AU - Qu, Dong

AU - Hui, Yi

AU - Johansen, Mathias

AU - Jensen, Anne Mette Baek

AU - Jarnvig, Inge Lise

AU - Strange, Ditte

AU - Jayashree, Muralidharan

AU - Reddy, Mounika

AU - Sankar, Jhuma

AU - Vijay Kumar, U.

AU - Lodha, Rakesh

AU - Lerner, Reut Kassif

AU - Paret, Gideon

AU - Schiller, Ofer

AU - Shostak, Eran

AU - Dagan, Ovadia

AU - Cavari, Yuval

AU - Chiusolo, Fabrizio

AU - Cillis, Annagrazia

AU - Camporesi, Anna

AU - Kneyber, Martin

AU - Otter, Suzan Cochiusden

AU - Van Hemeldonck, Ellen

AU - Beca, John

AU - Sherring, Claire

AU - Rea, Miriam

AU - Abadesso, Clara

AU - Moniz, Marta

AU - Jeyapalan, Asumthia

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Design: Prospective cohort study. Setting: Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. Patients: Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. Interventions: None. Measurements and Main Results: Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 109 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 109 cells/L (17-82 × 109 cells/L) for major bleeding, 42 × 109 cells/L (16-80 × 109 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 109 cells/L (17-72 × 109 cells/L) for minor bleeding, and 25 × 109 cells/L (10-47 × 109 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002; 95% CI, 1.001-1.003; p = 0.005). Conclusions: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.

AB - Objectives: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Design: Prospective cohort study. Setting: Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. Patients: Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. Interventions: None. Measurements and Main Results: Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 109 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 109 cells/L (17-82 × 109 cells/L) for major bleeding, 42 × 109 cells/L (16-80 × 109 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 109 cells/L (17-72 × 109 cells/L) for minor bleeding, and 25 × 109 cells/L (10-47 × 109 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002; 95% CI, 1.001-1.003; p = 0.005). Conclusions: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.

KW - Critical care

KW - Pediatrics

KW - Platelet transfusions

KW - Thrombocytopenia

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