Thrombocytopenia in preemies: poor outcomes with higher transfusion platelet count

  • Curley A & al.
  • N Engl J Med
  • 17 Jan 2019

  • curated by Emily Willingham, PhD
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • In preterm infants with severe thrombocytopenia, a higher transfusion platelet count threshold is linked to increased rates of mortality and major bleeding within 28 days.
  • A count of 50,000/mm3 was linked to far worse outcomes vs 25,000/mm3 in this multicenter, randomized trial.

Why this matters

  • Evidence-based guidance is limited for which threshold yields best outcomes in these infants, who commonly receive these transfusions to reduce bleeding risk.
  • Institutions vary in their choice of threshold.

Key results

  • In the high-threshold group vs the low-threshold group:
    • Major bleeding or death seen in 26% (85/324) vs 19% (61/329).
      • OR, 1.57 (95% CI, 1.06 to 2.32; P=.02).
    • Death in 15% vs 10%.
      • OR, 1.56 (95% CI, 0.95-2.55).
  • Groups did not differ for serious adverse events:
    • 25% vs 22% for high vs low.
    • OR, 1.14 (95% CI, 0.78-1.67).

Study design

  • Multicenter (43 sites in United Kingdom, Netherlands, Ireland), randomized trial, 660 preterm infants (median gestational age, 26.6 weeks; birth weight, 740 g).
  • Outcome: death or major new bleeding in 28 days.
  • Funding: Government and foundation funders.

Limitations

  • A small percentage of transfusions were additional ones, not indicated by protocol.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit