From the Research
Blood transfusions, specifically platelet transfusions, are not routinely recommended for infants with Down syndrome and thrombocytopenia, unless they have active bleeding or severe thrombocytopenia with a high risk of bleeding, as the latest evidence suggests that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates 1. The management of thrombocytopenia in infants with Down syndrome requires careful consideration of the underlying cause and the risk of bleeding.
- The typical dose for platelet transfusions is 10-15 mL/kg of platelet concentrate, but this should be individualized based on the patient's condition and response to transfusion.
- Platelet transfusions can immediately increase the circulating platelet count to reduce bleeding risk, but they do not address the underlying cause of thrombocytopenia.
- Ongoing monitoring is essential to determine the need for additional treatments beyond transfusions, and consultation with a pediatric hematologist is recommended in cases of severe or persistent thrombocytopenia. The latest study on this topic, published in 2019, found that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates, and that a strategy of therapeutic transfusions used only when patients have clinical bleeding might be as effective and safe for selected patients 1. Another study published in 2019 developed a dynamic prediction model for major bleeding in thrombocytopenic preterm neonates, which could help guide clinical decisions on platelet transfusions 2. However, the study from 2014 on the management of infants born with severe neonatal alloimmune thrombocytopenia suggested that transfusion of random-donor platelets alone was effective at correcting critically low platelet counts and should be considered as first-line treatment of newborns with unexpected severe NAIT 3. Overall, the decision to transfuse platelets in infants with Down syndrome and thrombocytopenia should be based on individual patient factors and the latest evidence, with a focus on minimizing the risk of bleeding and optimizing outcomes.