(P-TS-44) Epidemiology and Characteristics of Platelet Transfusions in Pediatric and Neonatal Recipients: A Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Database Study

Sunday, October 20, 2024

12:00 PM - 1:00 PM

Presenting Author(s)

Ruchika Goel, MD, MPH, CABP (she/her/hers)

Senior Medical Director, Corporate Medical Affairs. Professor of Internal Medicine and Pediatrics
Vitalant and Johns Hopkins University
Scottsdale, Arizona, United States

Background/Case Studies: Platelet (PLT) transfusions (PLTx) are a mainstay of therapy in neonates and children who are either bleeding (therapeutic transfusions) or at risk of bleeding (prophylactic transfusions). The objective of this study was to characterize the donors, products, and recipients of neonatal and pediatric platelet transfusions in U.S. hospitals.

Study

Design/Methods:

This multicenter retrospective observational study utilized the REDS-IV-P Vein-to-Vein database. Pediatric patients (age 0 to < 18 years; weight >2500g) admitted between March 31, 2019-July 1, 2023 from 8 participating hospitals were included. Blood component and recipient information was obtained from the 4 REDS-IV-P hubs. Demographic, clinical, and blood product characteristics were described as counts and percentages or median and interquartile range (IQR), as appropriate. Transfusion incidence was calculated as the binomial proportion of encounters during which at least one PLT product was transfused. Last PLT count (x10⁹ cells/L) within 24 hours prior to the transfusion was included as pre-transfusion count.

Results/Findings:

Of 250,456 inpatient encounters, any PLTx was reported in 8,140 (3.3%) of all subjects (male 3.4%, female 3.1%), with a median age of 3.9 (0.5-11.2) yrs and median weight 15.9 (6.8-40.9) kg. Based on age groups, children < 1 yr age had the lowest % PLTx at 2.5%, while 1-6 yrs had the highest (4.2%), (p.< 0.001). Black race had the lowest % PLTx at 2.1%, compared to 3.3% in whites and 4.4% in Native Hawaiian/Pacific Islanders (p.< 0.001). Median (IQR) pre-transfusion PLT counts in neonate were 34.0 (20.0,55.0) and significantly higher than non-neonates 22.0 (11.0,40.0), (p< 0.001). Median transfusion dose was 6.8 (4.4-11.1) ml/Kg. At least one concomitant RBC/plasma/Cryo transfusion (within 6 hrs of PLTx) was reported in 40.3% cases. Significant hub and hospital level variation were seen in PLTx incidence and utilization based on case mix indices (p< 0.001).

The median storage age was 4.5 (3.7-5.1) days, with 17% of PLT units stored >5 days. 100% were single donor apheresis products and leukoreduced, 62% were gamma-irradiated, 37% were pathogen-reduced (PR) [23% were PR PLTS in platelet-additive solutions].

Conclusions:

In this multicenter retrospective observational study spanning >250,000 inpatient encounters in neonates and children, PLTx were given to 3.3% subjects overall and there was co-transfusion with other blood components in 40% cases. 100% of the PLTS were single donor apheresis products, majority were irradiated, 2/5th were pathogen-reduced and 1/4th were suspended in PAS. Median storage age at time of Tx was 4.5 days with 1/6th of the PLTS being stored >5 days. Median pre-transfusion PLT count in neonates were significantly higher than non-neonates with an overall low median PLTx dose of ~7ml/Kg. Significant age, race and hub specific variations were seen in PLTx utilization.