Patient‐tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation
Background and Objectives Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the pre...
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| Veröffentlicht in: | Vox sanguinis 2024-04, Vol.119 (4), p.326-334 |
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| creator | Schiller, Ofer Pula, Giulia Shostak, Eran Manor‐Shulman, Orit Frenkel, Georgy Amir, Gabriel Yacobovich, Joanne Nellis, Marianne E. Dagan, Ovadia |
| description | Background and Objectives
Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80–100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient‐tailored platelet thresholds and related bleeding outcomes.
Materials and Methods
We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO‐supported paediatric patients in our unit.
Results
We found that more than 97.4% of patients had a platelet count |
| doi_str_mv | 10.1111/vox.13583 |
| format | Article |
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Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80–100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient‐tailored platelet thresholds and related bleeding outcomes.
Materials and Methods
We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO‐supported paediatric patients in our unit.
Results
We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications.
Conclusion
We have shown that a restrictive, ‘patient‐tailored’ rather than ‘goal‐directed’ platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.</description><identifier>ISSN: 0042-9007</identifier><identifier>EISSN: 1423-0410</identifier><identifier>DOI: 10.1111/vox.13583</identifier><identifier>PMID: 38175143</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Bleeding ; Blood platelets ; Blood transfusion ; Children ; Congestive heart failure ; Erythrocytes ; Extracorporeal membrane oxygenation ; Membranes ; Oxygenation ; packed red blood cells ; paediatric ; Patients ; Pediatrics ; Platelets ; Transfusion</subject><ispartof>Vox sanguinis, 2024-04, Vol.119 (4), p.326-334</ispartof><rights>2024 The Authors. published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.</rights><rights>2024 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.</rights><rights>2024. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3483-2db8c2a0cb6b4d71ee34b19914af1ed7377cb1251f308f3e464ab9533c7e6dce3</cites><orcidid>0000-0002-4607-1133</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fvox.13583$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fvox.13583$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38175143$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schiller, Ofer</creatorcontrib><creatorcontrib>Pula, Giulia</creatorcontrib><creatorcontrib>Shostak, Eran</creatorcontrib><creatorcontrib>Manor‐Shulman, Orit</creatorcontrib><creatorcontrib>Frenkel, Georgy</creatorcontrib><creatorcontrib>Amir, Gabriel</creatorcontrib><creatorcontrib>Yacobovich, Joanne</creatorcontrib><creatorcontrib>Nellis, Marianne E.</creatorcontrib><creatorcontrib>Dagan, Ovadia</creatorcontrib><title>Patient‐tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation</title><title>Vox sanguinis</title><addtitle>Vox Sang</addtitle><description>Background and Objectives
Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80–100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient‐tailored platelet thresholds and related bleeding outcomes.
Materials and Methods
We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO‐supported paediatric patients in our unit.
Results
We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications.
Conclusion
We have shown that a restrictive, ‘patient‐tailored’ rather than ‘goal‐directed’ platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.</description><subject>Bleeding</subject><subject>Blood platelets</subject><subject>Blood transfusion</subject><subject>Children</subject><subject>Congestive heart failure</subject><subject>Erythrocytes</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Membranes</subject><subject>Oxygenation</subject><subject>packed red blood cells</subject><subject>paediatric</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Platelets</subject><subject>Transfusion</subject><issn>0042-9007</issn><issn>1423-0410</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><recordid>eNp1kcFO3DAQhi1UxG4XDrxAZakXOIS1Y2fjHBEqUAkJDoC4WbYzoVk5cWo77e6NR-AZeRJMd-kBCV9Gsr75ZjQ_QoeUnND05n_c6oSyQrAdNKU8ZxnhlHxBU0J4nlWElBP0NYQlIUTkothDEyZoWVDOpsjdqNhCH1-enqNqrfNQ48GqCBYijl71oRlD63o8eGViayDgxnlsfrW29tDjMA6D8zF16TWGVeowzqcfUBZ30OlkAOxW60fo0yDX76PdRtkAB9s6Q3fnP27PLrOr64ufZ6dXmWFcsCyvtTC5IkYvNK9LCsC4plVFuWoo1CUrS6NpXtCGEdEw4AuudFUwZkpY1AbYDB1tvIN3v0cIUXZtMGBt2seNQeYVJbRaiHSEGfr-AV260fdpO8kIExUvEpyo4w1lvAvBQyMH33bKryUl8i0FmVKQ_1JI7LetcdQd1P_J97MnYL4B_rYW1p-b5P31w0b5Cob4lQY</recordid><startdate>202404</startdate><enddate>202404</enddate><creator>Schiller, Ofer</creator><creator>Pula, Giulia</creator><creator>Shostak, Eran</creator><creator>Manor‐Shulman, Orit</creator><creator>Frenkel, Georgy</creator><creator>Amir, Gabriel</creator><creator>Yacobovich, Joanne</creator><creator>Nellis, Marianne E.</creator><creator>Dagan, Ovadia</creator><general>Blackwell Publishing Ltd</general><general>S. 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Extracorporeal membrane oxygenation (ECMO) serves as cardiopulmonary therapy in critically ill patients with respiratory/heart failure and often necessitates multiple blood product transfusions. The administration of platelet transfusions during ECMO is triggered by the presence or risk of significant bleeding. Most paediatric ECMO programmes follow guidelines that recommend a platelet transfusion threshold of 80–100 × 109/L. To reduce exposure to platelets, we developed a practice to dynamically lower the threshold to ~20 × 109/L. We describe our experience with patient‐tailored platelet thresholds and related bleeding outcomes.
Materials and Methods
We retrospectively evaluated our platelet transfusion policy, bleeding complications and patient outcome in 229 ECMO‐supported paediatric patients in our unit.
Results
We found that more than 97.4% of patients had a platelet count <100 × 109/L at some point during their ECMO course. Platelets were transfused only on 28.5% of ECMO days; and 19.2% of patients never required a platelet transfusion. The median lowest platelet count in children who had bleeding events was 25 × 109/L as compared to 33 × 109/L in children who did not bleed (p < 0.001). Our patients received fewer platelet transfusions and did not require more red blood cell transfusions, nor did they experience more haemorrhagic complications.
Conclusion
We have shown that a restrictive, ‘patient‐tailored’ rather than ‘goal‐directed’ platelet transfusion policy is feasible and safe, which can greatly reduce the use of platelet products. Although there was a difference in the lowest platelet counts in children who bled versus those who did not, the median counts were much lower than current recommendations.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>38175143</pmid><doi>10.1111/vox.13583</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4607-1133</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Vox sanguinis, 2024-04, Vol.119 (4), p.326-334 |
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| language | eng |
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| source | Wiley Journals |
| subjects | Bleeding Blood platelets Blood transfusion Children Congestive heart failure Erythrocytes Extracorporeal membrane oxygenation Membranes Oxygenation packed red blood cells paediatric Patients Pediatrics Platelets Transfusion |
| title | Patient‐tailored platelet transfusion practices for children supported by extracorporeal membrane oxygenation |
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