In a study recently published in JAMA, researchers developed a model to predict the risks and benefits of platelet transfusions among infants with severe thrombocytopenia.
Platelet transfusions are a vital treatment option for infants with fetal and neonatal alloimmune thrombocytopenia (FNAIT) and other forms of thrombocytopenia. However, they may carry a risk of complications including bleeding. Prior studies have found that some infants may have a higher risk of adverse events than others, suggesting the need for improved prediction strategies.
The authors created their model using a cohort of preterm infants diagnosed with severe thrombocytopenia in the Netherlands, Sweden and Germany. Notably, individuals with FNAIT were excluded from this study.
The authors assessed patient records over 2-hour periods, called prediction points. At each point, they determined which patients received a platelet transfusion within six hours of that point and which did not receive a transfusion for at least three days. This allowed them to determine the safety of performing prophylactic, or preventative, transfusions versus waiting.
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For both strategies, the study evaluated the risk of major bleeding or death within three days. The model showed that the median risk of severe bleeding or death was 7.4% among those who received a prophylactic transfusion and 6.0% among those who did not.
The model also highlighted that regardless of which transfusion strategy was employed, the risk of adverse events differed based on a variety of clinical characteristics. This was the case even for patients who had the same platelet count.
In general, prophylactic platelet transfusions were less risky among infants with a platelet level below 20 x 109 / L, which is considered severely low. At higher platelet levels, the risks of transfusion appeared to outweigh the benefits.
“The algorithm’s risk estimates could help clinicians individualize prophylactic platelet transfusion decisions,” the authors concluded. “Expert consensus could define clinically relevant cutpoints in which the estimated risks of bleeding or mortality are meaningfully lower under prophylaxis than under no prophylaxis”
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