Improving Platelet Transfusion Practice

Applying best neonatal transfusion practices through transfusion stewardship programs can achieve better patient outcomes. Platelets, the focus of the present report, are the second most frequently transfused blood product in the neonatal intensive care unit (after red blood cell transfusion). Like many therapies in this field, platelet transfusions are associated with risks as well as benefits. Ongoing preclinical and clinical research continues to better define these risks and add to our understanding of disease pathogenesis. Although, in some instances, neonatal platelet transfusions obtained from adult donors can be lifesaving, mounting evidence suggests that such transfusions confer a dose-dependent risk of major bleeding, bronchopulmonary dysplasia, adverse neurodevelopment, and death. This review is intended to assist clinicians who care for hospitalized neonates by (1) clarifying the associations between platelet transfusions and adverse infant outcomes, (2) increasing awareness of a subset of neonates who are at high risk for receiving multiple platelet transfusions, (3) applying evidence-based restrictive platelet transfusion practices to mitigate the risks of platelet transfusions, and (4) highlighting both existing and novel experimental methods for treating thrombocytopenic neonates.