• Marianne E Nellis, Oliver Karam, Elizabeth Mauer, Melissa M Cushing, Peter J Davis, Marie E Steiner, Marisa Tucci, Simon J Stanworth, Philip C Spinella, and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) network, Pediatric Critical Care Blood Research Network (BloodNet), and the P3T Investigators.
• Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY.
• Crit. Care Med. 2018 Aug 1; 46 (8): 1309-1317.

ObjectivesLittle 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.DesignProspective cohort study.SettingMulticenter (82 PICUs), international (16 countries) from September 2016 to April 2017.PatientsChildren ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days.InterventionsNone.Measurements And Main ResultsOver 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 × 10 cells/L. The median (interquartile range) change in platelet count post transfusion was 48 × 10 cells/L (17-82 × 10 cells/L) for major bleeding, 42 × 10 cells/L (16-80 × 10 cells/L) for prophylactic transfusions to meet a defined threshold, 38 × 10 cells/L (17-72 × 10 cells/L) for minor bleeding, and 25 × 10 cells/L (10-47 × 10 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).ConclusionsThe 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.

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