Current guidelines for platelet transfusions in critically ill children are not supported by strong evidence. In general, they recommend a restrictive platelet transfusion strategy that considers other clinical factors. Researchers recently described platelet transfusion practices in 44 pediatric intensive care units (PICUs) in Spain, the U.K., and Italy during four predetermined seven-day periods in 2023. During the 28-day study, 2713 pediatric patients aged 1 month to 17 years were admitted to a PICU, and 4% (110/2713) received at least one platelet transfusion. Low platelet count (PC) was the main indication for platelet transfusions (54%); only 17% of platelet transfusion events were for active bleeding. Eighty-three percent of transfusion events were prophylactic, and the PC was greater than 50 x 109 cells/L in one third of transfusions—a level higher than the recommended restrictive threshold. The median pretransfusion PC was 36 x 109 cells/L across all transfused patients, but it was significantly higher among pediatric cardiology patients and lower among patients with septic shock or hematologic-oncologic conditions. Further research is needed to establish appropriate platelet thresholds and clinical triggers for platelet transfusions in children.
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