Greater than 10% of babies are born prematurely in Europe and the United States, and many of these infants have low platelet counts. The PlaNeT2/MATISSE trial, recently conducted in the U.K., Ireland, and the Netherlands, assessed platelet count thresholds for prophylactic transfusions in preterm infants. Six hundred sixty preterm babies (median gestational age 26.6 weeks) with thrombocytopenia were randomized in a 1:1 ratio to receive platelet transfusions when platelet counts dropped to 50,000/mm3 (high threshold group) or 25,000/mm3 (low threshold group). The infants in the high threshold group were more likely to die or have a major bleeding episode (85/324; 26%) compared to infants in the low threshold group (61/329; 19%) (odds ratio, 1.57; 95% CI, 1.06-2.32; P=0.02). Differences in serious adverse events were not observed between the high and low threshold groups. Platelet transfusions should be administered with caution at high platelet thresholds. Further studies are needed to fully understand the complex hemodynamic and immunologic relationships as they relate to major bleeding in preterm infants.
Reference:
