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Prophylactic platelet transfusion at higher thresholds was associated with increased risk of death or major bleeding in neonates
  1. Abdul Razak1,2,
  2. Ishrat Rahman3
  1. 1 Department of Pediatrics, King Abdullah bin Abdulaziz University hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Riyadh, Saudi Arabia
  2. 2 Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
  3. 3 Basic Dental Sciences, College of Dentistry, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
  1. Correspondence to Dr Abdul Razak, Division of Neonatology, Department of Pediatrics, King Abdullah bin Abdulaziz University hospital, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia ; razakmdpaed{at}gmail.com

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Study question

Should preterm infants (less than 34 weeks gestational age) with significant thrombocytopenia but no major bleeding receive prophylactic platelet transfusion at a threshold below 25 x109/L  or below 50 x109/L ?1

Design: Randomised clinical trial.

Patients

  • Inclusion criteria: Preterm infants less than 34 weeks’ gestational age admitted in neonatal intensive care unit with a platelet count of less than 50 000 per mm3 but no major intraventricular haemorrhage within 6 hours of randomisation.

  • Exclusion criteria: Major life-threatening congenital malformation, major bleeding within previous 72 hours, fetal intracranial haemorrhage, immune thrombocytopenia, infants who did not receive parenteral vitamin K or a low probability of survival beyond several hours. Infants with major bleeding included 72 hours later provided there was no further major bleeding.

Interventions: Infants received 15 mL/kg of body weight of platelet transfusion if the platelet counts were less than 25 x109/L (the low-threshold group) or less than 50 x109/L (the high-threshold group).

Outcomes: The primary outcome was death …

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