Point prevalence study of platelet transfusion in PICU
Research type
Research Study
Full title
Point Prevalence of Platelet Transfusions in Critically Ill Children (P3T)
IRAS ID
213829
Contact name
Peter J Davis
Contact email
Sponsor organisation
NHS Blood and Transplant
Duration of Study in the UK
0 years, 3 months, 1 days
Research summary
Summary of Research
Little is known about the practice of transfusing platelets in the paediatric intensive care unit, or the outcomes for children who receive platelet transfusions.
The aims of this international multi-centre point prevalence study are:
To describe the patterns of platelet transfusions among critically ill children, including dose, measured platelet count thresholds for transfusion and indication;
To assess the platelet a count increment and changes in platelet function parameters after platelet transfusions;
To describe the outcomes in critically ill children receiving platelet transfusions.Summary of Results
The conclusion from this part of the study was that the majority of platelet transfusions are given as prophylaxis to non-bleeding children and significant variation in thresholds for transfusion exists. Further studies are needed to clarify appropriate indications, with a focus on the use of prophylactic transfusions.Further sub-analysis of the worldwide data showed that 16% of children on Extracorporeal Life Support (ECLS) received at least one platelet transfusion. The majority of platelet transfusions were prescribed prophylactically for variable thresholds and in a large volume to children on ECLS and that again further research is warranted to identify the appropriate transfusion thresholds for children supported on ECLS.
Another sub-group analysis of the worldwide data was performed for children who received a platelet transfusion during one of the six predefined screening weeks of the study and had received chemotherapy in the previous 6 months or had undergone hematopoietic stem cell transplantation in the last year. The conclusions from this sub-analysis were that children with an underlying oncologic diagnosis receive nearly half of the platelet transfusions prescribed by paediatric intensivists, and that over half of these transfusions are prescribed at total platelet counts greater than current recommendations.
A secondary analysis to determine if transfusing ABO compatible platelets has any effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children was undertaken. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups irrespective of whether the child was bleeding or not. Similarly there were also no differences observed between the groups for any transfusion reaction.
Finally a secondary analysis of outcomes including platelet count increments, organ dysfunction and transfusion reactions were evaluated by platelet storage age. After adjusting for patient and product variables, there was no association between storage age and incremental change in total platelet count or organ dysfunction scoring. However a significant association between transfusing fresher platelets and febrile transfusion reactions was observed.
Overall this study and the sub-analyses and secondary analyses have provided a great deal of information on the use of platelet transfusions in critically ill children, but it is clear that further research is required on this topic, possibly through large-scale prospective studies.
REC name
London - West London & GTAC Research Ethics Committee
REC reference
17/LO/0217
Date of REC Opinion
26 Jan 2017
REC opinion
Favourable Opinion