159 - Platelet transfusion practices among Mexican neonatologists: Results of a national survey

Publication Number: 2153.159

Victoria Lima-Rogel, Hospital Regional de alta especialidad Dr. Ignacio Morones Prieto, San Luis Potosí, San Luis Potosi, Mexico; Ana-Ruth Mejía-Elizondo, Hospital Regional de Alta Especialidad Dr Ignacio Morones Prieto, San Luis Potosí, San Luis Potosi, Mexico; Martha Sola-Visner, Harvard Medical School, Boston, MA, United States

Background: Platelet transfusions are typically given to thrombocytopenic neonates at platelet count (PC) thresholds higher than those used in adults. However, a large randomized trial published in 2019 showed a higher incidence of major bleeding and/or death among preterm neonates transfused for PCs < 50,000/µL compared to those transfused for PCs < 25,000/µL.

Objective: The objective of this study was to evaluate current platelet transfusion practices among neonatologists in Mexico.

Design/Methods: We translated a survey of platelet transfusion practices in various clinical scenarios, previously used to characterize neonatal transfusion practices in North America (Pediatrics, 2009) and Europe (Transfusion, 2011), into Spanish, and adapted some questions to explore regional practices. The survey was sent via Google Forms to neonatologists leading local professional societies in each of the 32 Mexican states, who were asked to distribute it to their memberships.

Results: We received a total of 101 responses, originating from 29 of the 32 states, and representing both teaching and non-teaching hospitals. 59 of the 101 respondents had no institutional guidelines for neonatal platelet transfusions. There was great variability in the PC thresholds chosen for each clinical scenario. In clinically stable, non-bleeding preterm neonates, most neonatologists reported transfusing for PC thresholds ≤25,000/µL (Fig. 1), but the most commonly selected threshold was 50,000/µL in neonates with critical illness, intraventricular hemorrhage, undergoing procedures, or with necrotizing enterocolitis (Figs. 2 and 3). The most common volume administered was 10 mL/kg (56/101), and the most common duration of transfusion was 30 min (48/101). Interestingly, 53 of 101 respondents stated that they ordered platelet transfusions to be automatically repeated every 8, 12, or 24 hours (12, 28 and, 13 respondents, respectively) before rechecking a PC.

Conclusion(s): There is great variability in platelet transfusion practices among Mexican neonatologists, with PC thresholds >25,000/µL still being used in many clinical scenarios. More than 50% of our respondents also reported that they routinely order repeated platelet transfusions before checking the next platelet count, a practice not supported by the evidence. These findings support the need for additional education and the development and implementation of evidence-based guidelines.

Clinical scenario. Platelet trasnfusion threshold ELBW 1
Fig 1.jpegFig. 1

Clinical scenario 2. Platelet transfusion threshold lumbar puncture.
Fig 2..jpegFig.2

Clinical scenario 3. Platelet transfusion threshold NEC.
Fig 3.jpegFig.3