Platelet Usage Trends-Could It Be Less?

Abstract 4343

Thrombocytopenia as a risk factor for major bleeding is a life threatening complication of critical disease situations. Prophylactic or therapeutic platelet transfusions are widely used for hemorrhagic problems.

The aim of this study was to find out the indications, the threshold for platelet transfusion for the pediatric patients in a tertiary care hospital throughout one year to determine the optimal platelet transfusion practice.

The study was conducted upon the records of the hospital's blood bank and the files of the patients were retrospectively reviewed.

A total of 378 platelet units were used in 104 patients with an age range of 0–18 years. The majority (48.1 %) of the transfusions were in mainly leukemia patients in the hematology department. Transfusions per patient were higher in hematology (mean 4.8 ± 7.4 transfusions) and neonatology (mean 4.8 ± 7.6 transfusions) (p > 0.05) departments.

256 (67.7 %) of the transfusions were single donor apheresis whereas 122 (32.3 %) were random donor platelet products. About 1/3 of the apheresis products were given when the platelet count was below 10 × 10⁹/L and 1/3 were given when the platelet count was between 10–20 × 10⁹/L. 118 (31.2 %) of the transfusions were used for prophylaxis in hematology and oncology departments when the platelet levels were below 10×10⁹/L (mean platelet count of 9.8 ± 7.7 × 10⁹/L and 8.8 ± 5.2 × 10⁹/L). These levels are lower than other departments (p < 0.001). 59 % of the apheresis units were preferred for therapeutic reasons. The highest platelet levels were observed when platelet concentrates were used for treatment of bleeding or prior to any procedure (Table 1).

Platelet usage shows a discrepancy between the departments of pediatrics. Hematology and oncology patients were the major consumers of the platelet concentrates. Although it is known that when given in appropriate dosage no difference was observed between the platelet concentrates in terms of increasing the platelet counts, there was a tendency for using apheresis products which are the most expensive (188.61 dollars) among all. This practice could be abandoned by continuous education. Besides the guidelines should be reviewed periodically to remind the physicians the dilemma of transfusion; life saving on one hand and the risks on the other.