Objective Most platelet transfusions given in the NICU are prophylactic, because the platelet count has fallen below a somewhat arbitrary limit. Platelet transfusions in the NICU carry risks. We hypothesized that new evidence-based definitions of neonatal thrombocytopenia and stricter adherence to transfusion guidelines would reduce platelet transfusions.
Methods First, we re-examined the diagnosis of neonatal thrombocytopenia by electronically tabulating platelet counts from neonates in a multihospital healthcare system. Second, we examined every platelet transfusion given in the system during 2006, identifying those within vs in violation of guidelines. Third, we revised platelet transfusion guidelines based on platelet mass (platelet count X MPV).
Results Platelet counts were obtained from 47291 neonates 22 to 42 wks gestation and new definitions of thrombocytopenia devised. The lower reference range was 110,000/uL for those <34 wks, and 125,000/uL for those >34 wks. During 2006, 4% of our NICU patients received (median 3) platelet transfusions, but for those weighing <1000 g, 53% received platelet transfusions. 215 platelet transfusions were given, 148 of which (69%) were compliant with our guidelines. Had the new platelet mass-based guidelines been in place, and adhered to, transfusions would have been 99 (46% of the actual number given).
Conclusions Platelet counts as low as 110,000/uL are normal among neonates <34 wks. Improvements must be made in adhering to transfusion guidelines, and the guidelines should be reexamined. Intermountain Healthcare is currently piloting a new paradigm based on platelet mass. Safely reducing platelet transfusions in the NICU will likely improve outcomes and reduce costs.