Platelet transfusion practices in neonates and children vary widely, and several donor and product factors are associated with differences in posttransfusion platelet increments and overall transfusion burden, according to a multicenter cohort study published in JAMA Network Open.
Investigators analyzed 249,340 inpatient encounters from April 2019 to June 2023 using data from the NHLBI-funded REDS-IV-P Vein-to-Vein database. The study included patients younger than 18 years (excluding those with birth weights <2500 g). Neonates were defined as younger than 28 days.
Overall, 8,874 encounters (3.6%) involved at least one platelet transfusion. Transfusion rates were lowest in children younger than 1 year (2.6%) and highest in those aged 1 to younger than 6 years (4.7%).
A total of 40,779 platelet transfusion episodes were evaluated. Nearly one-third of platelet transfusions occurred within six hours of red blood cell, plasma, or cryoprecipitate transfusion.
After excluding patients with bleeding, most transfusions were given at relatively high pretransfusion platelet counts. In neonates, 67.8% were administered at counts greater than 25 × 10^3/μL. In older children, 81.0% were given at counts greater than 10 × 10^3/μL. Median pretransfusion platelet counts were higher in neonates than in older children (34 × 10^3/μL vs 22 × 10^3/μL; P < .001). Median transfusion dose was 14.9 mL/kg in neonates and 9.6 mL/kg in older children.
Several platelet processing and donor factors were associated with lower odds of achieving a posttransfusion platelet increment (PI) greater than 15 × 10^3/μL.
Use of platelet additive solution (PAS) (adjusted odds ratio [AOR], 0.32), pathogen reduction (PR) (AOR, 0.82), and storage longer than three days (AORs, 0.67–0.82) were linked to lower odds of achieving a PI greater than 15 × 10^3/μL. Male donor sex (AOR, 0.92) and donor age 40 years or older (AOR, 0.79) were also associated with lower increments.
These same factors were associated with increased transfusion burden, including PAS (adjusted rate ratio [ARR], 1.44) and longer storage duration (ARR up to 1.28).
However, none of the donor or product characteristics were associated with differences in hospital length of stay or in-hospital mortality after adjustment.
The findings highlight current platelet transfusion patterns in pediatric and neonatal populations and identify donor and processing characteristics associated with laboratory response and transfusion frequency.
The authors noted substantial variability in platelet transfusion thresholds, particularly in neonates, and emphasized that transfusion decisions should consider the broader clinical context rather than targeting a specific platelet increment.
Limitations included the retrospective design, inability to determine exact transfusion indications, post hoc bleeding definitions, and limited ability to adjust for illness severity.
Source: JAMA Network Open