-
Transfusion Medicine Reviews Jul 2021Preterm neonates with severe thrombocytopenia are frequently prescribed prophylactic platelet transfusions despite no evidence of benefit. Neonatal platelet transfusion... (Review)
Review
Preterm neonates with severe thrombocytopenia are frequently prescribed prophylactic platelet transfusions despite no evidence of benefit. Neonatal platelet transfusion practice varies, both nationally and internationally. Volumes and rates of transfusion in neonatology are based on historic precedent and lack an evidence base. The etiology of harm from platelet transfusions is poorly understood. Neonates are expected to be the longest surviving recipients of blood produce transfusions, and so avoiding transfusion associated harm is critical in this cohort. This article reviews the evidence for and against platelet transfusion in the neonate and identifies areas of future potential neonatal platelet transfusion research.
Topics: Blood Transfusion; Humans; Infant, Newborn; Platelet Transfusion; Thrombocytopenia
PubMed: 34312045
DOI: 10.1016/j.tmrv.2021.06.003 -
BMC Anesthesiology Jun 2015It is still common practice to correct abnormal standard laboratory test results, such as increased INR or low platelet count, prior to invasive interventions, such as... (Review)
Review
It is still common practice to correct abnormal standard laboratory test results, such as increased INR or low platelet count, prior to invasive interventions, such as tracheostomy, central venous catheter insertion or liver biopsy, in critically ill patients. Data suggest that 30-90 % of plasma transfused for these indications is unnecessary and puts the patient at risk. Plasma transfusion is associated with a high risk of transfusion-associated adverse events such as transfusion-associated circulatory overload (TACO), transfusion-related lung injury (TRALI), transfusion-related immunomodulation (TRIM), and anaphylaxis/allergic reactions. Therefore, the avoidance of inappropriate plasma transfusion bears a high potential of improving patient outcomes. The prospective study by Durila et al., published recently in BMC Anesthesiology, provides evidence that tracheostomies can be performed without prophylactic plasma transfusion and bleeding complications in critically ill patients despite increased INR in case of normal thromboelastometry (ROTEM) results. Thromboelastometry-based restrictive transfusion management helped avoid unnecessary plasma and platelet transfusion, and should reduce the incidence of transfusion-related adverse events and transfusion-associated hospital costs. Therefore, the authors believe that thromboelastometry-based strategies should be implemented to optimize patient blood management in perioperative medicine.
Topics: Critical Illness; Humans; Plasma; Platelet Transfusion; Pre-Exposure Prophylaxis; Thrombelastography
PubMed: 26054337
DOI: 10.1186/s12871-015-0074-0 -
Archives of Disease in Childhood. Fetal... Dec 2023To assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen...
OBJECTIVE
To assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen umbilical venous catheters (UVCs) and 24 G and 28 G peripherally inserted central catheters (PICCs).
DESIGN
Prospective in vitro controlled study.
SETTING
Blood transfusion service laboratory.
METHODS
In vitro platelet transfusions were set up as per NICU practice. Transfusion line pressure was monitored. Post-transfusion swirling, presence of aggregates, pH analysis and automated cell count in vitro activation response by flow cytometry assessing CD62P expression were assessed.
MAIN OUTCOME MEASURES
All transfusions completed successfully. The rate of infusion was reduced in 5 of 16 transfusions through 28 G lines due to 'pressure high' alarms. There was no difference in swirling values or transfusion aggregate formation, CD62P expression levels, platelet count, platelet distribution width, mean platelet volume, plateletcrit or platelet to large cell ratio across transfusions post-transfusion.
CONCLUSIONS
This study showed that in vitro platelet transfusion performed through 24 G and 28 G neonatal PICC lines and double-lumen UVCs is non-inferior to 24 G short cannulas, using outcome measures of platelet clumping, platelet activation and line occlusion. This suggests that where available these lines can be used if necessary for platelet transfusion.
Topics: Infant, Newborn; Humans; Platelet Transfusion; Intensive Care Units, Neonatal; Prospective Studies; Feasibility Studies; Catheters
PubMed: 37433587
DOI: 10.1136/archdischild-2023-325632 -
Pediatric Research Dec 2023Studies have demonstrated increased morbidity and mortality with platelet transfusions in the neonatal period. Platelets are as important for host immunity and... (Observational Study)
Observational Study
BACKGROUND
Studies have demonstrated increased morbidity and mortality with platelet transfusions in the neonatal period. Platelets are as important for host immunity and inflammation as for hemostasis. Increased inflammation may explain the dose-associated increase in mortality, bleeding, and lung disease.
OBJECTIVE
This study aims to assess if there are any changes in inflammatory cytokines post-platelet transfusion in babies in NICU.
METHODS
This prospective observational study recruited babies due to receive a non-emergency platelet transfusion. Dried whole blood samples were collected prior to and 2 h post-transfusion. Samples were processed using multiplex immunoassay to enable analysis of tiny blood volumes. Statistical analysis was performed using R.
RESULTS
Seventeen babies underwent 26 platelet transfusions across two centers. Median birthweight was 1545 g (535-3960 g) and median birth gestation was 31 weeks and 1 day (23 + 1 to 40 + 5). Median pre-transfusion platelet count was 19.5 × 10/l. There was a significant increase in levels of CXCL5 (p < 0.001), CD40 (p = 0.001), and TGF-β (p = 0.001) in neonatal blood samples post-platelet transfusion in the study group.
CONCLUSION
The increase in the cytokines CXCL5, CD40 and TGF-β after platelet transfusion in babies in NICU could potentiate existing inflammation, NEC, lung, or white matter injury. This could potentially explain long-term harm from platelet transfusion in babies.
IMPACT
There is a change in levels of immunomodulatory proteins CXCL5, CD40, and TGF-β after platelet transfusion in babies in NICU. Murine neonatal models have demonstrated an increase in cytokine levels after platelet transfusions. This is the first time that this has been demonstrated in human neonates. The increase in proinflammatory cytokines could potentially explain the long-term harm from platelet transfusion in babies, as they could potentiate existing inflammation, NEC, lung injury, or white matter injury.
Topics: Infant, Newborn; Humans; Animals; Mice; Platelet Transfusion; Blood Platelets; Cytokines; Inflammation; Transforming Growth Factor beta
PubMed: 37443343
DOI: 10.1038/s41390-023-02731-x -
Advances in Pediatrics 2008Some of the platelet transfusions currently given to NICU patients are unnecessary and convey no benefits. Although ordered with good intentions, unnecessary platelet... (Review)
Review
Some of the platelet transfusions currently given to NICU patients are unnecessary and convey no benefits. Although ordered with good intentions, unnecessary platelet transfusions carry known and unknown risks. Identifying and eliminating any unnecessary platelet transfusions in NICUs would be a step toward better care, lower costs, and more careful preservation of blood component resources. A renewed interest in platelet transfusion studies is needed, if essential data is to be gathered to improve NICU platelet transfusion practice. Retrospective studies can be of value: for instance, seeking associations between bleeding events and platelet counts can suggest the possibility of cause and effect relationships. Such studies might identify approximate platelet count levels that convey high hemorrhagic risk and might help focus future prospective trials. Prospective indirect studies also can be of value, for instance, measuring the template bleeding time and the PFA-100 closure time as a function of platelet count and perhaps as a function of circulating platelet mass, and would provide new information with relevance to platelet transfusion benefits. Such studies might give a better awareness of how low the platelet count can fall before platelet plug formation is impaired. It seems inescapable, however, that new, multicentered, randomized, prospective studies are needed, where NICU patients are assigned different platelet transfusion triggers and then carefully tracked for bleeding events and long-term neurodevelopmental outcomes. Only that type of study is likely to generate the evidence base needed for widespread implementation of improvements in NICU platelet transfusion practice.
Topics: Clinical Protocols; Hemorrhage; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Platelet Transfusion; Severity of Illness Index; Thrombocytopenia, Neonatal Alloimmune
PubMed: 19048733
DOI: 10.1016/j.yapd.2008.07.003 -
Transfusion and Apheresis Science :... Oct 2009Platelet transfusion therapy is the standard of care for thrombocytopenic patients with hemato-oncological disorders and bone marrow failure states due to intensive... (Review)
Review
Platelet transfusion therapy is the standard of care for thrombocytopenic patients with hemato-oncological disorders and bone marrow failure states due to intensive chemoradiotherapy. Guidelines to lower triggers for prophylactic and therapeutic transfusions are being developed based on better levels of evidence. The optimum transfusion dose, the choice of platelet concentrate and transfusion interval pose a challenge to balance scientific advances with cost-effective strategies. Platelet refractoriness requires "matched" platelets and is a difficult to treat phenomenon. Pathogen inactivation is a crucial issue in view of susceptibility of platelet concentrates to bacterial contamination. This article reviews the current developments and challenges in optimizing platelet transfusion therapy.
Topics: Blood Component Removal; Consensus; Humans; Platelet Transfusion
PubMed: 19717344
DOI: 10.1016/j.transci.2009.07.004 -
The Journal of Clinical Investigation Nov 2013The discovery of citrate anticoagulant in the 1920s and the development of plastic packs for blood collection in the 1960s laid the groundwork for platelet transfusion...
The discovery of citrate anticoagulant in the 1920s and the development of plastic packs for blood collection in the 1960s laid the groundwork for platelet transfusion therapy on a scale not previously possible. A major limitation, however, was the finding that platelet concentrates prepared from blood anticoagulated with citrate were unsuitable for transfusion because of platelet clumping. We found that this could be prevented by simply reducing the pH of platelet-rich plasma to about 6.5 prior to centrifugation. We used this approach to characterize platelet kinetics and sites of platelet sequestration in normal and pathologic states and to define the influence of variables such as anticoagulant and ABO incompatibility on post-transfusion platelet recovery. The "acidification" approach enabled much wider use of platelet transfusion therapy until alternative means of producing concentrates suitable for transfusion became available.
Topics: Anticoagulants; Blood Platelets; Blood Specimen Collection; Citric Acid; Glucose; History, 20th Century; History, 21st Century; Humans; Hydrogen-Ion Concentration; Platelet Aggregation; Platelet Transfusion; Thrombocytopenia
PubMed: 24177466
DOI: 10.1172/JCI70335 -
Blood Reviews Dec 1998The level of 20x10(9)/L for prophylactic platelet transfusion has rightly been challenged over the last few years, with some units recommending a level as low as... (Review)
Review
The level of 20x10(9)/L for prophylactic platelet transfusion has rightly been challenged over the last few years, with some units recommending a level as low as 5x10(9)/L. The higher levels are usually based on retrospective data from the 1950s. We examined the more recent data and came to the conclusion that a threshold of 10x10(9)/L is safe in the stable patient; higher levels are recommended for specific clinical circumstances. This threshold will reduce donor exposure, costs and possibly donor alloimmunization. The dearth of prospective controlled clinical trials in the literature also presents an opportunity for both in-house and national audit.
Topics: History, 20th Century; Humans; Platelet Transfusion
PubMed: 9950093
DOI: 10.1016/s0268-960x(98)90004-2 -
Transfusion Mar 2023
Topics: Humans; Blood Platelets; Blood Transfusion; Blood Component Removal; Platelet Transfusion; Isoantibodies
PubMed: 36939478
DOI: 10.1111/trf.17258 -
Transfusion Jan 2021Platelet (PLT) transfusions are an important component of hemostatic resuscitation. The AABB has published several guidelines recommending that PLT units should not be...
UNLABELLED
Platelet (PLT) transfusions are an important component of hemostatic resuscitation. The AABB has published several guidelines recommending that PLT units should not be infused through blood warming devices.
STUDY DESIGN AND METHODS
Thirty-one units of hospital blood bank apheresis PLTs were obtained. PLT-rich plasma (PRP) aggregometry and thromboelastography (TEG) were performed on the unit samples before and after the units were infused through a Ranger blood/fluid warming device.
RESULTS
There were no differences in any of the aggregometry results before and after infusion of the PLTs through the blood warmer (all P > .32). There was a significant reduction in the TEG maximum amplitude (MA) of 69.8 ± 7.9 mm before and 66.0 ± 8.8 mm after (P < .001) infusion of the PLTs through the blood warmer and α angle 61.8 ± 9.4° before and 59.3 ± 8.2° after (P = .044) infusion of the PLTs through the blood warmer, although both mean values were within normal range for the TEG and not clinically significant. There were very good correlations of aggregometry and TEG results before and after infusion of the PLTs through the blood warmer device.
CONCLUSION
This study did not demonstrate significant deleterious effect on PLT function from infusing apheresis PLT units through a blood warming device by PRP aggregometry. We did detect a statistically significant-but not clinically significant-reduction in TEG MA and α angle. The prohibition of transfusing PLT units though the Ranger blood warming device is not indicated.
Topics: Blood Banks; Blood Platelets; Blood Preservation; Humans; Platelet Function Tests; Platelet Transfusion; Resuscitation; Temperature; Thrombelastography
PubMed: 33078463
DOI: 10.1111/trf.16139