February 06, 2026
New results from a large multicenter cohort study provide insight on platelet transfusion practices, donor and platelet characteristics, and outcomes in neonates and children throughout the United States. The results, comprising data from approximately 250,000 patient encounters and more than 40,000 platelet transfusions during a four-year period, were published Jan. 28 in JAMA Network Open.
The analysis was conducted as part of the National Heart, Lung and Blood Institute–funded Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Program and used data from the program’s Vein-to-Vein database, which links blood donor, component and recipient information. The study included patients younger than 18 years; neonates were defined as those younger than 28 days of age.
The data demonstrated that overall, platelet transfusions were reported in 3.6% of inpatient neonatal and pediatric encounters, with a median of two platelet transfusions per encounter. Transfusion incidence varied by age, with the lowest rates observed among children aged younger than 1 year (2.6%) and the highest among those aged between 1 and 6 years (4.7%).
After excluding patients with evidence of bleeding, the investigators, led by Ruchika Goel, MD, MPH, CABP, examined pretransfusion platelet counts and posttransfusion platelet increments.
Among neonates, 67.8% of transfusions were performed at pretransfusion platelet counts greater than 25 × 103/µL, and the median pretransfusion platelet count was 34 ×10³/µL. In older children, 81% of transfusions were performed at pretransfusion platelet counts greater than 10 × 103/µL, and the median pretransfusion platelet count was 22 ×10³/µL.
Posttransfusion platelet increments were highest when transfusions were administered at lower pretransfusion platelet counts and declined as baseline counts increased. In both neonates and older children, negative platelet increments were observed when transfusions were given at pretransfusion platelet counts greater than 100 ×10³/µL.
The study also evaluated associations between platelet processing characteristics and posttransfusion platelet increments. Use of platelet additive solution (PAS), pathogen-reduced platelets and platelet storage durations longer than three days were each independently associated with decreased odds of posttransfusion PI higher than 15 × 103/µL.
The investigators also examined donor characteristics. Platelets from donors aged 40 years and older were associated with lower posttransfusion platelet increments compared with platelets from donors aged 25 to 40 years. Platelets from female donors were independently associated with higher posttransfusion platelet increments. The authors noted that some of these results could be explained by metabolomics analyses.
These platelet processing and donor characteristics were also associated with a higher overall platelet transfusion burden, defined as an increased likelihood of receiving additional platelet transfusions during the same hospitalization.
Despite these associations, the investigators found no relationship between platelet processing or donor characteristics and hospital length of stay or in-hospital mortality.
The investigators cautioned that posttransfusion platelet increment should not be viewed in isolation when assessing transfusion effectiveness. Although several platelet processing and donor characteristics were associated with lower platelet increments and higher transfusion burden, they noted that these factors were not associated with hospital length of stay or mortality.
Furthermore, they emphasized that the findings demonstrate substantial variability in neonatal and pediatric platelet transfusion practices, highlighting the need to tailor evidence-based guidelines to different patient populations and to conduct prospective studies to better define evidence-based transfusion strategies and optimize donor–component–recipient matching.
In an accompanying editorial, Meghan Delaney, DO, MPH, past president of AABB, noted that the findings largely align with prior reports with higher post-transfusion platelet increments observed at lower pretransfusion platelet counts.
Delaney also highlighted the ongoing clinical challenge of balancing transfusion safety and transfusion efficacy, particularly as newer platelet products such as pathogen-reduced platelets and PAS are associated with lower platelet count increments but have not been linked to adverse bleeding outcomes in prior studies.
She emphasized that how transfusion effectiveness is defined, by platelet count increments versus bleeding outcomes, remains an important consideration for clinical practice and future research.
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