Transfusion Guidelines Research Articles

Understanding the benefits of universal plasma and cryoprecipitate in hospitals in England.

Group AB plasma does not contain anti-A or anti-B antibodies and is therefore considered universal but is in limited supply (4% of the population). There is currently no licensed universal plasma available, and therefore current clinical guidelines for transfusion require the donor and recipient to be blood group compatible. We sought to understand the benefits of universal plasma to hospitals in England, to inform R&D priorities going forward. To understand the benefits of universal plasma (cryoprecipitate included), we distributed two surveys to hospitals (267 in total) in England. Safety was the perceived top benefit of universal plasma (95%), with cost identified as the main barrier to adoption (82%), although the majority of respondents were willing to pay more for universal components. Ninety-five respondents felt they would replace all or part of their stock holding with universal plasma, with 91% anticipating that their overall stock holding of plasma would reduce as well as there will be a reduction in their plasma wastage (by up to 25%). Hospitals (56%) thought that the availability of universal plasma would support more rapid provision of plasma for transfusion, particularly in emergency situations, with the emergency/trauma department deemed to be the area that would see the greatest benefit from these universal blood components. The response to both the potential clinical and operational benefits of a universal plasma and cryoprecipitate was positive.

Impact of implementing stricter criteria for blood transfusion in patients with head and neck cancer undergoing free tissue transfer.

Recent literature studying the impact of blood transfusion on outcomes in patients with head and neck cancer (HNC) have shown that blood transfusions are associated with increased risk of death and higher wound infection rates. The purpose of this study was to implement a lower transfusion threshold while comparing outcomes of free flap patients following initiation of a new transfusion guideline. A retrospective study of all patients at a tertiary care academic center who underwent free tissue transfer after HNC resection between July 17, 2007 and June 7, 2021. Transfusion criteria were adjusted in 2014; the hematocrit threshold to transfuse was incrementally reduced from 30% in 2007 to 21% in 2017. The main outcomes of interest were overall survival (OS) and recurrence free survival (RFS). A total of 346 patients met the criteria for inclusion in the study. Groups 1 (less strict protocol - 30%) and 2 (stricter protocol - 21%) consisted of 171 and 175 patients, respectively. Fewer units of packed red cells were transfused per patient in group 2 (0.26 vs. 2.87 in group 1, p < .001). Group 1 was associated with worse OS (p = .01; hazard ratio [HR] = 1.7) and RFS (p < .001; HR = 2.5). Comparing only patients with SCC between the two groups also demonstrated poorer OS (p = .01; HR = 1.8) and RFS (p = .006; HR = 2.1) in group 1. In HNC patients undergoing free tissue transfer, stricter transfusion criteria with threshold hematocrit of 21% was associated with improved OS, RFS, and complication rates with no negative impact on free flap survival. Level IV.

Distribution of ABO and D antigen expression in Yogyakarta, Java Island: a pioneer large-scale study in Indonesia

ObjectiveHere, we sought to report ABO and D antigen distribution in blood donors from Yogyakarta, Java Island, Indonesia. Phenotype data (ABO/D) from donors who donated blood between January 1, 2018, and December 31, 2023, at the Yogyakarta Blood Donor Unit were extracted from the blood donor registry, and phenotype frequency was calculated subsequently.ResultsIn the 245,307 blood donors collected over six years, ABO phenotype frequency: O (frequency: 38.5%) > B (29.4%) > A (24.1%) > AB (8.0%). The D-positive phenotype was far more common (99.5%) than the D-negative phenotype (0.5%). The phenotypic pattern globally is similar to previous reports in Southeast Asia. The D antigen distribution is similar to world distribution as the most common blood group. For the first time in Indonesia, this distribution of ABO and D phenotype is reported in a large-scale study. This work is a pioneer in the coordinated optimization of transfusion guidelines at the national level.

Data-driven education improves patient blood management: A pilot study

Abstract Introduction: We sought to increase the use of a restrictive transfusion protocol through clinician education and a standard approach to Patient Blood Management (PBM) in our gynecologic oncology service. Optimal PBM requires the consistent application of evidence-based, restrictive transfusion guidelines, however the use of restrictive transfusion is understudied in surgical oncology populations. We hypothesized that provider specific education that includes data derived from their own clinical practice would result in improved compliance current evidence-based transfusion guidelines. Methods: We created an educational activity that described evidence-based restrictive transfusion guidelines followed by data showing providers their own clinical transfusion practice where compliance with restrictive guidelines was poor. After the education, a plan to improve compliance was developed and put into place. Comparison of transfusion practices and complication/morbidity rates before and after the education was performed. Results: During the 18 months post-education the number of RBC units transfused decreased from 316 152, a 57% reduction and monthly transfusion events were reduced by 42% from 12 to 7 per month. The percent of transfusions with a pretransfusion hemoglobin less than 7 g/dL increased from 40% to 56%. The percent of transfusions with a hemoglobin less than 8 g/dL increased to 90%. Finally, the use of single unit transfusions increased from 49 to 85%, a major contributor to the reduction in units transfused. Conclusion: We created a service-specific educational intervention that improved compliance with evidence-based restrictive transfusion practice. This intervention improved provider compliance with lower transfusion thresholds and increased the use of single-unit transfusions.

Enhancing clinical insight: Implementing validated questionnaires for comprehensive assessment of clinician expertise in transfusion medicine practices

BackgroundBlood transfusion is a cornerstone of modern healthcare, pivotal in saving countless lives annually. However, inadequate knowledge among healthcare providers can lead to serious complications. Despite the availability of assessment tools like the Biomedical Excellence for Safer Transfusion (BEST) test, there is a need for indigenous-validated questionnaires to address knowledge gaps effectively. This study aimed to evaluate bedside transfusion medicine knowledge among clinical residents using a validated questionnaire, focusing on knowledge gaps. Study design and methodsA cross-sectional study was conducted at a tertiary care referral center in Northern India. The questionnaire, developed based on national and international transfusion guidelines, was validated by an expert panel, and administered to 245 clinical residents. The questionnaire covered six domains related to transfusion medicine: blood component storage, blood bank procedures, transfusion-transmitted infections, administration of blood components, transfusion reactions, and transfusion practices. ResultsThe study revealed varying levels of knowledge across specialties and residency years. Overall, residents scored 61 % in transfusion medicine knowledge, with Pediatrics residents demonstrating the highest scores. The incremental increase in knowledge from first to third-year residents underscores the value of continuous, experience-based learning throughout the residency period. DiscussionStudy highlights significant knowledge gaps in bedside transfusion practices among clinical residents, emphasizing the need for structured educational interventions. Tailored programs, integrated into undergraduate and postgraduate curricula, are essential to improve transfusion safety and patient outcomes. Addressing these gaps can lead to better bedside transfusion practices, reducing risks and improving the quality of patient care.

Assessment of knowledge of blood transfusion and its associated factors among nurses and midwives at public hospitals in Ethiopia: Cross-sectional study

BackgroundNurses and midwives administer blood to the patient, however, the status of knowledge of nurses and midwives to deliver safe blood transfusions in the current setting needs to be investigated. ObjectiveTo assess knowledge of blood transfusion and its associated factors among nurses, and midwives at public hospitals in West Shoa, Ethiopia, 2021. MethodAn institutional-based cross-sectional study was carried out among 278 randomly selected nurses and midwives working in public hospitals of West Shoa from August 1 to 30, 2021. Data were collected through a self-administered questionnaire to evaluate knowledge of blood transfusion of nurses and midwives. Finally, data were entered into Epi-data v.3.1 and transferred to SPSS v.26 for analysis. Bivariate logistic analysis was performed, and variables with a p-value of <0.25 were included in the multivariable regression analysis. Statistical significance was determined at a P value of <0.05 with an adjusted odd ratio. Result267 participants took part in the study, achieving a 96 % response rate, and about (57.3 %) of participants had inadequate knowledge of blood transfusion. Work experience (AOR = 2.51, 95 % CI: 1.04, 6.08), guidelines available in the ward (AOR = 2.75, 95 % CI: 1.50, 5.01), and reading guidelines (AOR = 5.43, 95 % CI: 2.91, 10.16) were significant association with knowledge of blood transfusion. ConclusionOver half of nurses and midwives had inadequate knowledge of the appropriate blood transfusion. Work experience, availability of blood transfusion guidelines in the ward, and reading guidelines were significant associations with knowledge. Provide continuous in-service training, and educational programs to enhance participants' knowledge of blood transfusion.

A clinical audit of red blood cell transfusion practices at a district hospital in South Africa.

Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n= 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n= 52) of the cases, the guidelines were applied appropriately. The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution:The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.

Implementing evidence-based restrictive neonatal intensive care unit platelet transfusion guidelines.

Platelet transfusions are life-saving treatments for specific populations of neonates. However, recent evidence indicates that liberal prophylactic platelet transfusion practices cause harm to premature neonates. New efforts to better balance benefits and risks are leading to the adoption of more restrictive platelet transfusion guidelines in neonatal intensive care units (NICU). Although restrictive guidelines have the potential to improve outcomes, implementation barriers exist. We postulate that as neonatologists become more familiar with the data on the harm of liberal platelet transfusions, enthusiasm for restrictive guidelines will increase and barriers to implementation will decrease. Thus, we focused this educational review on; (1) the adverse effects of platelet transfusions to neonates, (2) awareness of platelet transfusion "refractoriness" in thrombocytopenic neonates and its association with poor outcomes, and (3) the impetus to find alternatives to transfusing platelets from adult donors to NICU patients.

Retrospective evaluation of plasma transfusions in dogs undergoing general anaesthesia: 85 cases (2017–2021)

ObjectiveTo describe the use of plasma transfusion in anaesthetized dogs, specifically the triggers for use, the population administered plasma, reported adverse events and human errors associated with transfusion. Study designRetrospective observational study. AnimalsA total of 85 client-owned dogs. MethodsA search of electronic transfusion and anaesthetic records at a university teaching hospital was performed to identify dogs administered plasma during the study period (January 2017 to June 2021). Data collected included signalment, surgical procedure, intraoperative triggers for transfusion, the type of plasma, rate of transfusion and the presence of transfusion reactions, human errors or deviation from transfusion guidelines. ResultsDuring this period, 85 dogs were administered plasma. Sepsis was diagnosed in 49/85 (58%) dogs, with 42/85 (49%) animals undergoing surgery for septic peritonitis. Perianaesthetic hypotension contributed to the decision to administer plasma in 67/85 (79%) dogs. In 33/85 (39%) dogs, hypotension was the only reason for transfusion, while 31/85 (36%) had other influencing factors, most commonly hypoproteinaemia. Fresh frozen plasma was administered in 95% of cases. Only 31% of transfusions were started at a slower ‘test dose’ rate and 79% of dogs administered boluses of plasma. No definite, probable or possible transfusion reactions were identified using current veterinary guidelines. Conclusions and clinical relevancePlasma transfusions were commonly administered to dogs presenting with sepsis for haemodynamic optimization. Clinicians often chose to bolus plasma instead of initiating transfusions at the recommended initial slow starting rate. No transfusion reactions were identified; however, some reactions may have been masked by the effects of general anaesthesia and/or have been difficult to recognize in this critically ill canine population.

Reducing Adverse Events Associated with Pediatric Cardiac Catheterization: A Quality Improvement Project Focusing on Decreasing Catheterization-Associated Blood Transfusions.

The objective of this study is to describe interventions and outcomes of a quality improvement (QI) project to reduce red blood cell transfusion (RBCT) within 72h of pediatric cardiac catheterization. Using Plan-Do-Study-Act (PDSA) methodology, we applied interventions including (1). Intraprocedural-to reduce hemodilution, blood loss, and excessive anticoagulation, (2). Standardization of institutional transfusion criteria, and (3). "Hard stop" requiring QI team consultation prior to elective post-catheterization RBCT. Primary outcome measures were frequency of RBCT from IMPACT quarterly reports and cases between transfusions (CBT). Length of stay (LOS) was the primary countermeasure. Characteristics of patients who did and did not receive RBCT were compared. 698 pediatric cardiac catheterizations occurred between 4/2017 and 8/2023. Intraprocedural interventions did not alter frequency of RBCT or CBT. Standardized transfusion guidelines followed by the "hard stop" decreased RBCT frequency from 10 to 1.9% and increased CBT without increasing LOS. Patients requiring RBCT were younger (medians 0.31 vs 2.4years), smaller (5.2 vs 11.8kg), and had longer procedures (2.24 vs 1.57h) all p < 0.001. Single ventricle patients were more likely to have RBCT than simple biventricular patients (14.1% vs 3.1%; RR = 4.57, 95% CI 2.29-10.4; p < 0.001). Procedure type (diagnostic vs. intervention) and starting hemoglobin concentration were comparable between groups. Programmatic adherence to standardized peri-procedural transfusion guidelines successfully decreased RBCT without compromising patient care or increasing LOS. Younger age, lower weight, procedure length, and single ventricle physiology were all associated with RBCT risk.

Consensus transfusion guidelines for a large neonatal intensive care network.

Consensus transfusion guidelines for a large neonatal intensive care network.

Should HLA and HPA-matched platelet transfusions for patients with Glanzmann Thrombasthenia or Bernard-Soulier syndrome be standardized care? A Dutch survey and recommendations.

Glanzmann thrombasthenia (GT) and Bernard-Soulier syndrome (BSS) patients require frequent platelet transfusions and hence have an increased risk for alloimmunization against donor Human Leukocyte Antigens (HLA) when no HLA-matching is performed. Knowing that Human Platelet Antigens (HPA) are located on the platelet glycoproteins that can be absent in these patients, preventive HPA-matching may also be considered. Uniform recommendations on this topic lack in transfusion guidelines making standard practice unclear, therefore, we aimed to provide a framework for matched platelet transfusions. We conducted a targeted literature search and a national survey of Dutch (pediatric) hematologists from July to September 2021. We found 20 articles describing platelet transfusion policies in 483 GT-patients and 29 BSS-patients, both adults and children. Twenty surveys were returned for full analysis. All responders treated patients with platelet disorders, including GT (n = 36 reported) and BSS (n = 29 reported). Of respondents, 75% estimated the risk of antibody formation as "likely" for HLA and 65% for HPA. Formation of HLA antibodies was reported in 5 GT and in 5 BSS-patients, including one child. Fifteen respondents gave preventive HLA-matched platelets in elective setting (75%). Three respondents additionally matched for HPA in GT-patients (15%). Main argument for matched platelet transfusions was preventing alloimmunization to safeguard the effectivity of 'random' donor-platelets in acute settings. Elective HLA-matching for GT and BSS-patients is already conducted by most Dutch (pediatric) hematologists. HPA-matching is mainly applied when HPA-antibodies are formed. Based on the current literature and the survey, recommendations are proposed.

Neonatal Blood Transfusion in Africa; Towards Optimizing Scarce Resource

Neonatal transfusion is a common practice in Africa, where many infants are born with low birth weight and require blood transfusions. The use of paediatric packs for neonatal blood transfusions has been recommended. However, the optimal use of these packs in Africa is not clearly understood by some healthcare practitioners. This review aims to provide insights into the optimal use of paediatric packs in neonatal transfusion in Africa.The World Health Organization (WHO) recommends restrictive transfusion practices for paediatric patients, including neonates, based on expert opinion. Transfusion triggers in neonates are controversial and mainly based on expert clinical opinion, although recent randomized controlled trials of ‘liberal’ versus ‘restrictive’ red cell transfusion policies in very low birth weight preterm babies are starting to influence clinical guidelines. Many neonatal red cell transfusions are given to replace losses from frequent blood sampling. This can be reduced by avoiding non-essential tests, using low-volume sample tubes, validated near patient testing, micro-techniques in the laboratory, and non-invasive monitoring where possible.The use of CMV-seronegative blood products for transfusion in low birth weight neonates is not deemed necessary. The primary rationale is that the risk of transfusion-transmitted infections should be reduced by stringent screening of donors, restrictive transfusion practice and certain interventions like irradiation of blood units before transfusion. A recent international survey of transfusion practices for extremely premature infants showed that factors considered “very important” regarding the need to administer blood transfusions included degree of oxygen requirement and need for respiratory support. Donor exposure can also be reduced by allocating single donor units, split into paedipacks, to babies predicted to need more than one transfusion episode within the expiry date of the donation. Implementing a program to improve compliance with neonatal intensive care unit transfusion guidelines was accompanied by a reduction in transfusion rate. The implementation of guidelines to improve compliance with neonatal intensive care unit transfusion guidelines can also reduce the transfusion rate.

Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review.

Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.

Transfusion Camp Rwanda 2023: A train-the-trainer workshop establishing locally driven leadership in knowledge translation and sustainability in transfusion medicine education.

Blood transfusion is performed daily in hospitals. Gaps exist between transfusion guidelines and day-to-day clinical care. These gaps are prevalent in resource-limited settings due to scarce continuing medical education. Transfusion Camp Rwanda aims to bridge this gap by (1) delivering context-appropriate up-to-date education, (2) teaching participants how to independently deliver a case-based curriculum and (3) identifying strategies to promote change in transfusion practice in Rwanda. In May 2023, a multidisciplinary team from Canada and Rwanda carried out a Transfusion Camp train-the-trainer workshop for clinicians from all five provinces in Rwanda. Participants attended in-person lectures, seminars and workshop group discussions on the implementation of the Rwanda National Directives on Rational Use of Blood and Blood Components. Course feedback was based on the Kirkpatrick Model of Training and Evaluation. Fifty-one physicians and laboratory technicians participated in the course. Confidence in caring for patients based on transfusion guidelines was self-rated as 'excellent' by 23% of participants before and 77% after, while 84% reported they planned to teach Transfusion Camp to others and 100% responded that they will apply course content to clinical practice. Workshop groups recommended strategies to improve transfusion medicine practice in Rwanda in four domains: Communication, Institutional Approval, Practice Audits and Education. Transfusion medicine education in Rwanda using a train-the-trainer approach was well-received by participants and allowed for a more detailed understanding of the local medical and educational environment. These observations can inform the further expansion of the Transfusion Camp Rwanda project.

The 2023 AABB international guidelines for red blood cell transfusions: What is new?

The 2023 AABB international guidelines for red blood cell transfusions: What is new?

Patient blood management guideline for adults with critical bleeding.

The management of patients with critical bleeding requires a multidisciplinary approach to achieve haemostasis, optimise physiology, and guide blood component use. The 2011 Patient blood management guidelines: module 1 - critical bleeding/massive transfusion were updated and published. Systematic reviews were conducted for pre-specified research questions, and recommendations were based on meta-analyses of included studies. The critical bleeding/massive transfusion guideline includes seven recommendations and 11 good practice statements addressing: major haemorrhage protocols (MHPs) facilitating a multidisciplinary approach to haemorrhage control, correction of coagulopathy and normalisation of physiological derangement; measurement of physiological, biochemical and metabolic parameters in critical bleeding/massive transfusion; the optimal ratio of red blood cells to other blood components; the use of tranexamic acid; viscoelastic haemostatic assays; and cell salvage. The new guideline recommends MHPs be established as standard of care in all institutions managing patients with critical bleeding. In addition to routine physiological markers, the new guideline recommends temperature, biochemistry and coagulation profiles be measured early and frequently, providing parameters that define critical derangements. Ratio-based MHPs should include no fewer than four units of fresh frozen plasma and one adult unit of platelets for every eight units of red blood cells. In the setting of trauma and obstetric haemorrhage, administration of tranexamic acid within three hours of bleeding onset is recommended. The use of recombinant activated factor VII (rFVIIa) is not recommended. There was insufficient evidence to make recommendations on the use of viscoelastic haemostatic assays or cell salvage as part of MHPs.

Red Blood Cell Transfusion Practice Pattern Before and After Implementation of a Local Restrictive Transfusion Protocol in a Neonatal Intensive Care Unit

Background: A restrictive red blood cell (RBC) transfusion guideline was established in 2019 in a neonatal intensive care unit (NICU), suggesting a hemoglobin concentration threshold of 7 g/dL. Objectives: (a) To determine its impact on the number of RBC transfusions and donor exposure; (b) to characterize RBC-transfusion determinants and justifications. Study Design: Single-center retrospective historical control study comparing all neonates consecutively admitted to the NICU during two five-month periods: 401 patients in 2013 before and 402 patients in 2021 after restrictive guideline implementation. Possible determinants were assessed via logistic regressions and justifications via a questionnaire. Results: In 2021, 9.2% of neonates received at least one RBC transfusion compared to 13.5% in 2013 ( p = .075). Adherence to protocol thresholds was 50%. Implementation of a restrictive transfusion protocol had some impact on determinants related to neonatal morbidity and illness severity and some impact on justifications being mainly based on hemoglobin value. Conclusion: Our study demonstrates that the implementation of a restrictive RBC transfusion protocol tended to decrease transfusion rates and donor exposure in the NICU, but the trend was not statistically significant. Future work should focus on improving protocol adherence.

Rational Transfusion in Clinical Practice: Walking the Tight Rope

Transfusion therapy has undergone a significant evolution from whole blood transfusions to highly specialized blood component therapy. There is enough evidence in the literature that estimates that half of the transfusions given to the patients were actually not required as their hemoglobin can be improved with the help of alternative methods. The introduction of patient blood management (PBM) marks a paradigm shift in clinical transfusion practice and anemia management, emphasizing a patient-centric approach. PBM strategies aim to preserve and improve the patient’s blood, thereby reducing the need for allogeneic blood transfusions. PBM strategies include treating anemia, correcting coagulopathy, and minimizing blood loss. Every healthcare facility should plan to implement PBM as a multidisciplinary and multi-professional program, requiring collaboration from clinicians, public health professionals, and hospital administration. Thus, PBM implementation requires a comprehensive business plan, evidence-based transfusion guidelines, education, and a clinical decision support system. Data acquisition, analysis, audits, and reports play a crucial role in continuously improving the healthcare system and enhancing patient safety.

Platelet transfusion practices among neonatologists in Saudi Arabia: A nationwide cross-sectional survey.

The etiologies of thrombocytopenia are highly diverse; however, early neonatal thrombocytopenia might be more common among extremely low-weight neonates. Therefore, in this study, we aimed to examine the current neonatal platelet (PLT) transfusion practices in Saudi Arabia. This is a cross-sectional online survey study that was conducted between October and December 2022. Convenience sampling was used to recruit the participants. In this study, we developed a questionnaire based on an extensive literature review to examine current neonatal PLT transfusion practices. A total of 81 neonatologists participated. The vast majority of them (85.2%) were practicing in a level 3 neonatal intensive care unit, with 60.0% of them reporting that they transfuse PLTs over 1 hour. Around 53% reported that they typically order 10 mL/kg per PLT transfusion. Up to 34.6% of the study participants reported that they use pooled whole-blood-derived PLT products in their practicing unit. Almost half (48.0%) of the study participants reported that they have written guidelines for PLT transfusion in their practicing unit, with 81.1% reporting that the PLT transfusion threshold was stated in the guidelines. Neonatal thrombocytopenia is typically treated with PLT transfusions. PLT transfusion criteria should be lowered in light of recent evidence suggesting that doing so may be counterproductive. However, there is some disagreement about whether a PLT count constitutes a medical emergency requiring a transfusion for a newborn baby. Furthermore, there is a great deal of variation in the administration of PLT infusions in Saudi Arabia because of the absence of clear protocols. Strict neonatal PLT transfusion standards and carefully planned clinical research are needed to address the risks and/or benefits of these diverse methods.