0946 Severe thrombocytopaenia and platelet transfusion in neonates

Over the past few years a group of researchers in Utah has published several papers on neonatal thrombocytopaenia: aetiologies, clinical presentations, indications for platelet transfusion, and outcomes for transfused and untransfused infants. In a recent article, 11281 patients from 5 Utah centres were enrolled between 2003 and 2007. The authors were specifically interested in subjects with platelet counts below 50 000/μl (which they defined as severe thrombocytopaenia) and looked at when it occurred, associated conditions and treatment. Platelets were administered if counts were <100 000 with ECMO or just pre- or post-surgery; with counts of <50 000 and unstable; or with counts of <20 000. Some 273 patients (2.4%) qualified for inclusion with one or more episodes of thrombocytopaenia, of which 42 had multiple episodes. Almost 25% were diagnosed on day 1, with others diagnosed at up to >150 days. Bacterial and fungal infections were responsible for 33%, SGA or pregnancy-induced hypertension for 22%, NEC for 14% and DIC for 13%. There was a strong inverse correlation between birthweight and thrombocytopaenia, with almost 20% of <750g neonates experiencing the problem, 10% of 750-1000g, 4% of 1001-1500g and 2% of 1501-2000g. Cutaneous and gastrointestinal haemorrhages were related to (low) platelet counts, whereas pulmonary and intraventricular haemorrhages were more related to other factors. The most interesting finding was the stepwise mortality increase with increasing number of platelet transfusions (~15% with 2-5 transfusions, 25% with 6-10, 35% with 11-20, and 50% with>20). This obviously raises the question of whether transfusions themselves are noxious, or are required more in the sickest infants. While there is little doubt about the latter, the authors have also shown in a previous paper that there appears to be an independent role of the platelet transfusions in patient mortality. Based on the latter and as reported in yet another study in which 36% of platelet transfusions were given in violation of protocols (i.e. without clear indication), a strong case is made for administering platelets only where there are clear clinical indications and not prophylactically.

Read more:
Pediatrics 2009; 124: e1095-e1100
Transfusion 2009; 49: 869-72
J Perinatol 2007; 27: 790-6