Personalized Prediction Model of Prophylactic Platelet Transfusions for Preterm Infants

International transfusion guidelines based on one large randomized controlled trial for preterm infants with severe thrombocytopenia (platelet count < 50 X 10⁹/L) recommend prophylactic platelet transfusions when platelet counts fall below 25 X 10⁹/L. Questions remain, however, about the ideal platelet threshold, and whether prophylactic platelet transfusions reduce the risk of bleeding and death in these infants. A recent study developed a dynamic prediction model to estimate individualized risk of major bleeding or death with and without prophylactic platelet transfusions in preterm infants with severe thrombocytopenia using gestational age, weight, and onset of thrombocytopenia as time-fixed variables along with 6 other time-dependent variables including platelet count and transfusions. The model development cohort consisted of 1042 preterm infants (median gestational age, 28 weeks; 900 g median birth weight; 59% male) from 10 NICUs in the Netherlands, Sweden, and Germany; 23% of which experienced major bleeding or death within 10 days of developing severe thrombocytopenia. The median predicted 3-day risk of major bleeding or death was 7.4% (IQR, 4.2% to 14.3%) for infants receiving platelet transfusions compared to 6.0% (IQR, 2.6% to 16.3%) in infants who did not receive a transfusion. Importantly, the study found that an infant’s risk of major bleeding or death was dependent on platelet count and other clinical characteristics, but that platelet transfusions were beneficial when platelet counts fell below 20 X 10⁹/L. Additional studies are needed to confirm this model and guide clinicians in the decision to transfuse preterm infants.

References:

1. van der Staaij H, Prosepe I, Caram-Deelder C, Keogh RH, et al. Individualized Prediction of Platelet Transfusion Outcomes in Preterm Infants With Severe Thrombocytopenia. JAMA. 2025 Sep 15:e2514194. doi: 10.1001/jama.2025.14194. Epub ahead of print. PMID: 40952748; PMCID: PMC12439188.
2. Metcalf RA, Dhiman P, Stanworth SJ. Personalized Platelet Transfusion Predictions for Neonates. JAMA. 2025 Sep 15. doi: 10.1001/jama.2025.14389. Epub ahead of print. PMID: 40952725.