A study recently published in The Journal of Pediatrics found that critically ill children who receive a platelet transfusion before central venous line (CVL) placement may be at increased risk of bleeding events. These findings are relevant for a number of indications including fetal and neonatal alloimmune thrombocytopenia (FNAIT), which is characterized by low platelet levels.
CVL placement is a common technique employed in the pediatric intensive care unit (PICU) to provide nutrients and medication to patients. “The risk of bleeding with CVL placement in critically ill pediatric patients, however, is not well known and no identified studies have looked specifically at this population,” the authors explained.
The study included 363 patients aged 0 months to 19 years who were admitted to the PICU at Massachusetts General Hospital for Children between January 1, 2012 and March 1, 2022. All participants underwent CVL placement during their admission to the PICU.
Among the participants, 26 experienced bleeding events, 92% of which were minimal and 8% of which were moderate. Additionally, low platelet counts and platelet transfusion prior to CVL placement were both associated with an increased risk of bleeding events.
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After creating a model including platelet count, age, sex, history of transfusion before CVL placement, number of CVL attempts and Pediatric Logistic Organ Dysfunction (PELOD-2) score, the study found that only sex and history of platelet transfusion were associated with bleeding events. Specifically, females and patients who received a platelet transfusion were more likely to experience a bleeding event.
The authors noted that participants receiving platelet transfusions had significantly lower PELOD-2 scores than those not receiving a transfusion, suggesting that this patient subpopulation had a poorer baseline health status before CVL placement.
“Until results of such studies emerge, pediatric critical care physicians should not assume that any specific platelet count serves as a reliable trigger for platelet transfusion and should evaluate the risks and benefits of pre-procedure platelet transfusions on an individual case basis,” the study concluded.
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