The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns

Abstract

Introduction: Almost 95% of the platelet transfusions (PTs) conducted in the neonatal intensive care unit (NICU) are prophylactic transfusions. Guidelines for prophylactic PTs are based on platelet counts, but not on platelet functions. Nowadays, in order to reduce unnecessary transfusions, utilizing platelet mass index (PMI) was investigated. The aim of study is to find out whether PTs performed in our NICU during last 2 years were in accordance with the current guideline and to evaluate whether the frequency of PTs should be reduced if PMI was considered.Methods: Forty-three infants who received 96 prophylactic PTs were enrolled in the study. The guideline utilized in our NICU advocate keeping the platelet count: (a) >100 000 in pre/post-operative, (b) >50 000 in unstable and (c) >20 000 in stable patients. According to PMI criteria, PT should be performed if PMI: (a) <800 in pre/post-operative, (b)<400 in unstable and (c) <160 in stable patients.Results: In all, 53.2% of PTs should not be given if the decision was in accordance with the current guideline. If decision for every PT was made according to the current guideline and taking PMI into consideration, an additional 11.5% reduction in total PTs could be achived.Conclusion: We suggest that better compliance with the new guidelines which take platelet functions into account may yield lower transfusion rate, lower costs and better conservation of blood bank resources.