In Pediatric Patients, Increased Platelet Transfusion Linked to Higher Risk of Infection, Thrombosis and Mortality

Each additional platelet transfusion increases the risk of thrombosis, infection and mortality among pediatric patients by 1%, 2% and 6%, respectively, according to the results of a retrospective analysis of more than 4 million children and teens published in the April 2023 issue of Hospital Pediatrics.

The findings, along with other epidemiologic results, highlight “the need to be thoughtful in weighing risks and benefits when prescribing repeated platelet transfusions to hospitalized children,” according to the authors.

The researchers also found that the platelet transfusion prevalence from 2010 to 2019 was 3.89% with 145,218 children out of 4 million, who received at least one platelet transfusion in a hospital.  The number of children receiving at least one platelet transfusion per year did not significantly vary over the time period. However, the number of children who underwent procedures in the operating room, received invasive mechanical ventilation, and were supported by extracorporeal membrane oxygenation (ECMO) all significantly increased during that time.

The results come from a retrospective cohort study of hospitalized children within the administrative Pediatric Health Information System (PHIS) database, which is includes inpatient, emergency department, ambulatory surgery, and observation unit encounters from more than 50 children’s hospitals affiliated with the Children’s Hospital Association. Patients up to age 18 years were included in the analysis if they received at least one platelet transfusion per hospitalization between 2010 and 2019.

The majority of platelet transfusions (2/3) were given to children 6 years and younger; more than half of those children were younger than 1 year 6 years. The median (interquartile range) age of children was 3 years, and just over half (55%) were male. Patients who received platelet transfusion were transfused once (median, interquartile range) during a hospital stay. Patients who received platelet transfusion stayed in the hospital a media (interquartile range) of 10 days.

Among patients who received at least one platelet transfusion, 3% had a thrombus, 1% had a nosocomial infection and 8% died.

The researchers noted that children with diseases of the circulatory system, perinatal disorders, or hematologic and/or immune system disorders were the most likely to receive transfusion. These are “patient populations that can be targeted for pediatric blood management programs.”

As part of the discussion, they pointed out that “the need for consideration of more restrictive transfusion practices is highlighted by recent literature reporting increased morbidity and mortality associated with platelet transfusions. Among critically ill children, platelet transfusions have been associated with an increased risk of transfusion-related acute lung injury, febrile nonhemolytic transfusion reactions and organ failure.”