Abstract
Aim: Thrombocytopenia is a common clinical problem in neonatal intensive care units (NICU). Hemorrhagea due to thrombocytopenia is rare than expected and 95% of platelet transfusions (PTs) in NICU are prophylactic transfusions. We aimed to evaluate our previous PTs according to PMI and compare the effect of platelet count based guideline (PCBG) and PMI based guidelines in transfusion decision, and whether the frequency of PTs should be reduced if PMI based guideline was considered.
Material and Methods: Prophylactic PTs performed between January 1, 2013 and December 31, 2015 were evaluated. Data was obtained from medical records.
Results: Prophylactic PT number was 66 in 48 patients, and account for 28% of platelet transfusions. Median gestational age and birthweight were 32 (23-41) weeks and 1670 (450-4095) g, respectively. 22 of the patients were 1500 g. There was no bleeding episode in these patients. Compliance with PCBG was 96% (64/66). If PMI based guideline was used, 3 of the PTs should not have been performed and 4.5% reduction could be achieved.
Conclusions: Compliance with guideline strictly even which of PCBG or PMI based guideline used seems to be primary factor to eleminate unnecessary PTs and to reduce tranfusion associated risks. Platelet mass index may be used as supportive if compliance of PCBG is highly adhered.
Keywords
prophylactic platelet transfusion platelet count based guideline platelet mass index based guideline unnecessary platelet transfusion newborn
References
- 1. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol 2009;29(2):130-136.
- 2. Christensen RD, Henry E, Wiedmeier SE, et al. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol 2006;26(6):348-353.
- 3. Christensen RD, Henry E, Del Vecchio A. Thrombocytosis and thrombocytopenia in the NICU: incidence, mechanisms and treatments. J Matern Fetal Neonatal Med 2012;25 Suppl 4:15-17.
- 4. Christensen RD. Platelet transfusion in the neonatal intensive care unit: benefits, risks, alternatives. Neonatology 2011;100(3):311-318.
- 5. Christensen RD. Advances and controversies in neonatal ICU platelet transfusion practice. Adv Pediatr 2008;55:255-269.
- 6. Sola-Visner M. Platelets in the neonatal period: developmental differences in platelet production, function, and hemostasis and the potential impact of therapies. Hematology Am Soc Hematol Educ Program 2012;2012:506-511.
- 7. Estcourt LJ, Stanworth SJ, Murphy MF. Prophylactic platelet transfusions. Curr Opin Hematol 2010;17(5):411-417.
- 8. Christensen RD, Paul DA, Sola-Visner MC, Baer VL. Improving platelet transfusion practices in the neonatal intensive care unit. Transfusion 2008;48(11):2281-2284.
- 9. Eldor A, Avitzour M, Or R, Hanna R, Penchas S. Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume. Br Med J (Clin Res Ed) 1982;285(6339):397-400.
- 10. Gerday E, Baer VL, Lambert DK, et al. Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit. Transfusion 2009;49(10):2034-2039.
- 11. Von Lindern JS, van den Bruele T, Lopriore E, Walther FJ. Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort study. BMC Pediatr 2011;11:16.
- 12. Del Vecchio A, Motta M, Radicioni M, Christensen RD. A consistent approach to platelet transfusion in the NICU. J Matern Fetal Neonatal Med 2012;25(Suppl 5):93-96.
- 13. Baer VL, Lambert DK, Henry E, Snow GL, Sola-Visner MC, Christensen RD. Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system. J Perinatol 2007;27(12):790-796.
- 14. Baer VL, Lambert DK, Schmutz N, et al. Adherence to NICU transfusion guidelines: data from a multihospital healthcare system. J Perinatol 2008;28(7):492-497.
- 15. Baer VL, Henry E, Lambert DK, et al. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre-post analysis within a multihospital health care system. Transfusion 2011;51(2):264-269.
- 16. Petaja J, Andersson S, Syrjala M. A simple automatized audit system for following and managing practices of platelet and plasma transfusions in a neonatal intensive care unit. Transfus Med 2004;14(4):281-288.
- 17. Kahvecioglu D, Erdeve O, Alan S, et al. The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns. J Matern Fetal Neonatal Med 2014;27(17):1787-1789.
- 18. Zisk JL, Mackley A, Clearly G, Chang E, Christensen RD, Paul DA. Transfusing neonates based on platelet count vs. platelet mass: a randomized feasibility-pilot study. Platelets 2014;25(7):513-516.
- 19. Yavuzcan Ozturk D, Ercin S, Gursoy T, Karatekin G, Ovali F. Platelet mass index: is it a hope for reduction of platelet transfusion in NICU? J Matern Fetal Neonatal Med 2016;29(12):1926-1929.
Abstract
Amaç: Trombositopeni yenidoğan yoğun bakım ünitelerinde (YYBÜ) sık görülen bir problemdir. Trombositopeniye sekonder kanama tahmin edilenden azdır ve platelet transfüzyonlarının (PT) %95’i profilaktik olarak yapılmaktadır. Ortalama platelet hacminin (OPH) yüksek olması genç, aktif ve daha etkili platelet plağı oluşumu ile ilişkilendirilmiş ve kanamanın OPH düşük olanlara göre daha az olduğu bildirilmiştir. Bu çalışmada geçmiş PT’larımızı platelet kitle indeksine (PKİ, OPH x platelet sayısı / 1000 ) göre değerlendirmek; platelet sayısı ve PKİ’e dayanan kılavuzların transfüzyon kararı üzerine etkilerini değerlendirmek ve PKİ’e dayanan kılavuz kullanılmış olsaydı transfüzyon sayısında azalma olup olmadığını değerlendirmeyi amaçladık.
Gereçler ve Yöntemler: 1 Ocak 2013 ve 31 Aralık 2015 arasında yapılan profilaktik PT’ları değerlendirildi. Veriler hastane kayıtlarından elde edildi.
Bulgular: Profilaktik PT 48 hastada 66 kez yapılmıştı ve tüm PT’larının %28’iydi. Ortanca gestasyonel yaş ve doğum ağırlığı 32 (23-41) hafta ve 1670 (450-4095) gramdı. Hastalardan 22’si 1500 gramın altındaydı. Profilaktik PT yapılan hastaların hiçbirisinde kanama gözlenmedi. Platelet sayısına dayalı kılavuza uyum 96%’ydı. Eğer PKİ’e dayalı kılavuz kullanılsa idi 3 profilaktik PT’u yapılmayacaktı ve transfüzyon sayısında %4.5 azalma olacaktı.
Çıkarımlar: Gereksiz PT sayısını ve transfüzyon ilişkili riskleri azaltmak için ilk olarak hangi transfüzyon kılavuzu kullanılırsa kullanılsın sıkı bir şekilde uyulması gereklidir. Platelet kitle indeksi platelet sayısına dayalı kılavuza sıkı bir şekilde uyuluyor ise transfüzyon kararı verirken destekleyici olarak kullanılabilir.
Keywords
profilaktik platelet transfüzyonu platelet kitle indeksi gereksiz platelet transfüzyonu yenidoğan
References
- 1. Wiedmeier SE, Henry E, Sola-Visner MC, Christensen RD. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol 2009;29(2):130-136.
- 2. Christensen RD, Henry E, Wiedmeier SE, et al. Thrombocytopenia among extremely low birth weight neonates: data from a multihospital healthcare system. J Perinatol 2006;26(6):348-353.
- 3. Christensen RD, Henry E, Del Vecchio A. Thrombocytosis and thrombocytopenia in the NICU: incidence, mechanisms and treatments. J Matern Fetal Neonatal Med 2012;25 Suppl 4:15-17.
- 4. Christensen RD. Platelet transfusion in the neonatal intensive care unit: benefits, risks, alternatives. Neonatology 2011;100(3):311-318.
- 5. Christensen RD. Advances and controversies in neonatal ICU platelet transfusion practice. Adv Pediatr 2008;55:255-269.
- 6. Sola-Visner M. Platelets in the neonatal period: developmental differences in platelet production, function, and hemostasis and the potential impact of therapies. Hematology Am Soc Hematol Educ Program 2012;2012:506-511.
- 7. Estcourt LJ, Stanworth SJ, Murphy MF. Prophylactic platelet transfusions. Curr Opin Hematol 2010;17(5):411-417.
- 8. Christensen RD, Paul DA, Sola-Visner MC, Baer VL. Improving platelet transfusion practices in the neonatal intensive care unit. Transfusion 2008;48(11):2281-2284.
- 9. Eldor A, Avitzour M, Or R, Hanna R, Penchas S. Prediction of haemorrhagic diathesis in thrombocytopenia by mean platelet volume. Br Med J (Clin Res Ed) 1982;285(6339):397-400.
- 10. Gerday E, Baer VL, Lambert DK, et al. Testing platelet mass versus platelet count to guide platelet transfusions in the neonatal intensive care unit. Transfusion 2009;49(10):2034-2039.
- 11. Von Lindern JS, van den Bruele T, Lopriore E, Walther FJ. Thrombocytopenia in neonates and the risk of intraventricular hemorrhage: a retrospective cohort study. BMC Pediatr 2011;11:16.
- 12. Del Vecchio A, Motta M, Radicioni M, Christensen RD. A consistent approach to platelet transfusion in the NICU. J Matern Fetal Neonatal Med 2012;25(Suppl 5):93-96.
- 13. Baer VL, Lambert DK, Henry E, Snow GL, Sola-Visner MC, Christensen RD. Do platelet transfusions in the NICU adversely affect survival? Analysis of 1600 thrombocytopenic neonates in a multihospital healthcare system. J Perinatol 2007;27(12):790-796.
- 14. Baer VL, Lambert DK, Schmutz N, et al. Adherence to NICU transfusion guidelines: data from a multihospital healthcare system. J Perinatol 2008;28(7):492-497.
- 15. Baer VL, Henry E, Lambert DK, et al. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate: a pre-post analysis within a multihospital health care system. Transfusion 2011;51(2):264-269.
- 16. Petaja J, Andersson S, Syrjala M. A simple automatized audit system for following and managing practices of platelet and plasma transfusions in a neonatal intensive care unit. Transfus Med 2004;14(4):281-288.
- 17. Kahvecioglu D, Erdeve O, Alan S, et al. The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns. J Matern Fetal Neonatal Med 2014;27(17):1787-1789.
- 18. Zisk JL, Mackley A, Clearly G, Chang E, Christensen RD, Paul DA. Transfusing neonates based on platelet count vs. platelet mass: a randomized feasibility-pilot study. Platelets 2014;25(7):513-516.
- 19. Yavuzcan Ozturk D, Ercin S, Gursoy T, Karatekin G, Ovali F. Platelet mass index: is it a hope for reduction of platelet transfusion in NICU? J Matern Fetal Neonatal Med 2016;29(12):1926-1929.
Details
| Primary Language | English |
|---|---|
| Subjects | Paediatrics |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | December 31, 2019 |
| Submission Date | December 28, 2019 |
| Acceptance Date | January 11, 2020 |
| Published in Issue | Year 2019 Volume: 16 Issue: 4 |
