From the Research
No, platelets should not be given to this preterm infant. Despite the low platelet count of 45 × 10^9/L, prophylactic platelet transfusions in stable preterm infants without active bleeding have not been shown to reduce the risk of intraventricular hemorrhage (IVH) 1. Current evidence suggests that platelet transfusions should be reserved for active bleeding or counts below 25-30 × 10^9/L in preterm infants. This infant has minimal oozing at puncture sites but no significant bleeding, normal cranial ultrasound, and is hemodynamically relatively stable.
Key Considerations
- The most recent and highest quality study, a systematic review and meta-analysis published in 2023, found that platelet transfusions in preterm infants are associated with a higher risk of death, sepsis, and necrotizing enterocolitis (NEC) 1.
- Another study published in 2022 found that platelet transfusion was significantly associated with mortality, and a decreased platelet count was significantly associated with any grade IVH, severe IVH, and mortality 2.
- A systematic review published in 2019 found that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates 3.
- The evidence suggests that a restrictive platelet transfusion threshold is preferred, and the risk of a decreased platelet count should not be ignored.
Risks of Platelet Transfusions
- Unnecessary platelet transfusions carry risks including fluid overload, transfusion reactions, and potential lung injury.
- The risks associated with platelet transfusions should be carefully weighed against the potential benefits in each individual case.
Monitoring and Management
- Instead of platelet transfusion, close monitoring of the platelet count, hemodynamic status, and serial cranial ultrasounds would be appropriate for this infant.
- The infant's condition should be closely monitored, and platelet transfusion should only be considered if there is active bleeding or a significant decrease in platelet count.