Is Platelet Mass Index Useful to Reduce Prophylactic Platelet Transfusions in Neonates?

Abstract

Aim: Thrombocytopenia is a common clinical problem in neonatal intensive care units (NICU). Hemorrhagea due to thrombocytopenia is rare than expected and 95% of platelet transfusions (PTs) in NICU are prophylactic transfusions. We aimed to evaluate our previous PTs according to PMI and compare the effect of platelet count based guideline (PCBG) and PMI based guidelines in transfusion decision, and whether the frequency of PTs should be reduced if PMI based guideline was considered. Material and Methods: Prophylactic PTs performed between January 1, 2013 and December 31, 2015 were evaluated. Data was obtained from medical records. Results: Prophylactic PT number was 66 in 48 patients, and account for 28% of platelet transfusions. Median gestational age and birthweight were 32 (23-41) weeks and 1670 (450-4095) g, respectively. 22 of the patients were 1500 g. There was no bleeding episode in these patients. Compliance with PCBG was 96% (64/66). If PMI based guideline was used, 3 of the PTs should not have been performed and 4.5% reduction could be achieved. Conclusions: Compliance with guideline strictly even which of PCBG or PMI based guideline used seems to be primary factor to eleminate unnecessary PTs and to reduce tranfusion associated risks. Platelet mass index may be used as supportive if compliance of PCBG is highly adhered.

Keywords

• prophylactic platelet transfusion,platelet count based guideline,platelet mass index based guideline,, unnecessary platelet transfusion,newborn

Is Platelet Mass Index Useful to Reduce Prophylactic Platelet Transfusions in Neonates?

Abstract

Amaç: Trombositopeni yenidoğan yoğun bakım ünitelerinde (YYBÜ) sık görülen bir problemdir. Trombositopeniye sekonder kanama tahmin edilenden azdır ve platelet transfüzyonlarının (PT) %95’i profilaktik olarak yapılmaktadır. Ortalama platelet hacminin (OPH) yüksek olması genç, aktif ve daha etkili platelet plağı oluşumu ile ilişkilendirilmiş ve kanamanın OPH düşük olanlara göre daha az olduğu bildirilmiştir. Bu çalışmada geçmiş PT’larımızı platelet kitle indeksine (PKİ, OPH x platelet sayısı / 1000 ) göre değerlendirmek; platelet sayısı ve PKİ’e dayanan kılavuzların transfüzyon kararı üzerine etkilerini değerlendirmek ve PKİ’e dayanan kılavuz kullanılmış olsaydı transfüzyon sayısında azalma olup olmadığını değerlendirmeyi amaçladık. Gereçler ve Yöntemler: 1 Ocak 2013 ve 31 Aralık 2015 arasında yapılan profilaktik PT’ları değerlendirildi. Veriler hastane kayıtlarından elde edildi. Bulgular: Profilaktik PT 48 hastada 66 kez yapılmıştı ve tüm PT’larının %28’iydi. Ortanca gestasyonel yaş ve doğum ağırlığı 32 (23-41) hafta ve 1670 (450-4095) gramdı. Hastalardan 22’si 1500 gramın altındaydı. Profilaktik PT yapılan hastaların hiçbirisinde kanama gözlenmedi. Platelet sayısına dayalı kılavuza uyum 96%’ydı. Eğer PKİ’e dayalı kılavuz kullanılsa idi 3 profilaktik PT’u yapılmayacaktı ve transfüzyon sayısında %4.5 azalma olacaktı. Çıkarımlar: Gereksiz PT sayısını ve transfüzyon ilişkili riskleri azaltmak için ilk olarak hangi transfüzyon kılavuzu kullanılırsa kullanılsın sıkı bir şekilde uyulması gereklidir. Platelet kitle indeksi platelet sayısına dayalı kılavuza sıkı bir şekilde uyuluyor ise transfüzyon kararı verirken destekleyici olarak kullanılabilir.

Keywords

• profilaktik platelet transfüzyonu,platelet kitle indeksi,gereksiz platelet transfüzyonu,yenidoğan

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