Platelet Transfusion Practices for Critically Ill Children: A 28-Day Point-Prevalence Study in Three European Countries in 2023.
Butragueño-Laiseca L., Sarfatti A., Ray S., Stanworth SJ., Carter MJ., Calderón-Llopis B., Álvarez P., Leal A., López E., Morteruel E., Campos Rodríguez R., Caligiuri MF., Perdichizzi S., Dei Giudici L., Chiusolo F., European PEdiatric TRAnsfusion Practices in PICU (E-PETRA) Investigators and the United Kingdom Pediatric Critical Care Society Study Group (PCCS-SG) .
ObjectivesTo study the prevalence, indications, thresholds, and outcomes of platelet transfusions in critically ill children in three European countries.DesignInternational 4-week point-prevalence study in 2023.SettingForty-four PICUs across Spain, the United Kingdom, and Italy.PatientsPICU patients of 1 month to 17 years old receiving platelet transfusions.InterventionsNone.Measurements and main resultsDuring four prespecified 7-day blocks, 110 of 2713 (4.1% [95% CI, 3.4-4.9%]) patients received at least one platelet transfusion, accounting for 253 transfusions. The primary indication was a low platelet count (PC) (54% [95% CI, 48-60%]), and 83% (95% CI, 77.7-87.4%) were prophylactic indications. Active bleeding was the main reason for transfusion in only 17% of cases (12.6-22.2). Median pretransfusion PC was 36 × 109 cells/L. PC differed significantly across diagnostic subgroups and indications. It was higher in postsurgery cardiac (83 × 109 cells/L) and nonsurgery cardiac patients (61 × 109 cells/L) and lower in septic shock (24 × 109 cells/L) and hemato-oncological conditions (23 × 109 cells/L). Posttransfusion (2 hr) PC increment was 42 × 109/L, but by 12-24 hours it decreased to 13 × 109/L, regardless of patient diagnosis or reason for transfusion. Viscoelastic testing was performed in only seven events (2.8%). The 28-day PICU mortality was 21.8% (95% CI, 14.6-30.4%). The number and total dose of transfusions were associated with mortality, even after adjusting for the Pediatric Index of Mortality III score.ConclusionsIn 44 European PICUs in 28 days during 2023, 4% of admitted patients received platelet transfusions. PC was the primary reason for transfusion, with substantial variability between subgroups and indications. There were a high number of prophylactic transfusions, and exceeding the recommended restrictive threshold was common. The observed change in the patients' PC is not related to the reason for the platelet transfusion or the patient's diagnosis. Viscoelastic testing is still rarely performed. These results support the need for pediatric trials to define safe and effective platelet thresholds and to evaluate the role of other transfusion triggers in critically ill children.