From the Research
The most recent and highest quality study, 1, suggests that prophylactic platelet transfusions for preterm neonates may not reduce mortality or major bleeding, and therefore, I recommend using a lower threshold of 25,000/μL for platelet transfusions in clinically stable preterm infants. This approach is supported by the study's findings that platelet transfusions have limited effectiveness in reducing bleeding risk and may even be associated with increased mortality and bleeding in neonatal randomized trials. Some key points to consider when implementing this approach include:
- Platelet transfusions should be given at 10-20 mL/kg of platelet concentrate over 30-60 minutes when counts fall below 25,000/μL.
- Higher thresholds (50,000/μL) may still be appropriate for neonates with active bleeding, before invasive procedures, or with clinical instability.
- The use of lower thresholds for platelet transfusions can help reduce unnecessary transfusions and their associated risks, including fluid overload, transfusion reactions, and potential inflammatory responses. As noted in 2, recent trials support the use of lower platelet transfusion thresholds in preterm neonates, although data is limited to guide transfusion among more mature neonates. Additionally, 3 highlights the variability in neonatal platelet transfusion practice and the need for further research to establish evidence-based guidelines. Overall, the available evidence suggests that a more restrictive approach to platelet transfusions in preterm neonates can be safe and effective, and may even reduce the risks associated with transfusions, as noted in 4 and 5.