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Objective <p>Thrombocytopenia is a common problem affecting preterm neonates. Recent studies show increased morbidity and mortality with liberal platelet transfusion thresholds. We sought to standardize thrombocytopenia management through a transfusion guideline to reduce excessive transfusions.</p> Study design <p>We developed and implemented a guideline using PDSA cycles for infants with birth weights &lt;1000 grams. Platelet transfusions were classified as indicated or non-indicated per the guideline. Severe (grade 3 or 4) intraventricular hemorrhage and pulmonary hemorrhage rates were balancing measures.</p> Results <p>We analyzed 101 infants pre-guideline and 96 infants post-guideline. The mean monthly non-indicated transfusions significantly decreased from 13.0 to 2.0, respectively (<i>p</i>-value &lt; 0.01). Incidence of severe grade IVH and pulmonary hemorrhage remained stable.</p> Conclusion <p>Rapid implementation of an evidence-based, restrictive platelet transfusion guideline significantly reduced non-indicated platelet transfusions without a concomitant increase in major bleeding events.</p>

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Development and implementation of restrictive platelet transfusion thresholds in a neonatal intensive care unit

  • 期刊论文

  • 发表日期：

    2025年4月21日

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  • Natasha Lalos,
  • Alexa Brumfiel,
  • Luke T. Viehl,
  • Gillian C. Pet,
  • Alexandra Lahart

摘要

Objective

Thrombocytopenia is a common problem affecting preterm neonates. Recent studies show increased morbidity and mortality with liberal platelet transfusion thresholds. We sought to standardize thrombocytopenia management through a transfusion guideline to reduce excessive transfusions.

Study design

We developed and implemented a guideline using PDSA cycles for infants with birth weights <1000 grams. Platelet transfusions were classified as indicated or non-indicated per the guideline. Severe (grade 3 or 4) intraventricular hemorrhage and pulmonary hemorrhage rates were balancing measures.

Results

We analyzed 101 infants pre-guideline and 96 infants post-guideline. The mean monthly non-indicated transfusions significantly decreased from 13.0 to 2.0, respectively (p-value < 0.01). Incidence of severe grade IVH and pulmonary hemorrhage remained stable.

Conclusion

Rapid implementation of an evidence-based, restrictive platelet transfusion guideline significantly reduced non-indicated platelet transfusions without a concomitant increase in major bleeding events.