Platelet Transfusion Practices in Critically Ill Children

Objectives: Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. Design: Prospective cohort study. Setting: Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. Patients: Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. Interventions: None. Measurements and Main Results: Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50 × 10⁹ cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 10⁹ cells/L (17-82 × 10⁹ cells/L) for major bleeding, 42 × 10⁹ cells/L (16-80 × 10⁹ cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 10⁹ cells/L (17-72 × 10⁹ cells/L) for minor bleeding, and 25 × 10⁹ cells/L (10-47 × 10⁹ cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1 mL/kg platelets transfused, 1.002; 95% CI, 1.001-1.003; p = 0.005). Conclusions: The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.