Pediatric anesthesia & critical care
Platelet Transfusion Practices and Outcomes in Neonates and Children
Authors' conclusion
Use of PAS, PR, longer storage duration, male donors, and donor age older than 40 years were independently associated with lower posttransfusion platelet increments. Use of PAS, PR, platelet storage longer than 3 days, and donor age 40 years or older were associated with a significantly higher overall platelet transfusion burden but were not associated with hospital length of stay or mortality.
Study context
- Population
- Patients <18 years (birth weight >2500 g) receiving platelet transfusion, REDS-IV-P database, April 2019–June 2023; neonates <28 days vs older childrenof 249,340 inpatient encounters
- Participants
- 8,874 patients
- Exposure
- Platelet processing and donor characteristics
- Outcome
- Posttransfusion platelet increments and subsequent transfusion burden associated with platelet processing and donor characteristics
Methodological detailsmulticenter, donor-component-recipient-linked database
- Multicenter
- Donor-component-recipient-linked database
Main finding
As reported in the abstract
Lower posttransfusion platelet increments
Adjusted odds ratio (95% CI)P value
PR
0.82(0.73–0.92)
P < 0.001PAS
0.32(0.27–0.37)
P < 0.001Storage >3 daysAORs ranged from 0.67 to 0.82
0.67(0.58–0.76)
P < 0.001Storage >3 daysupper end of range
0.82(0.76–0.88)
P < 0.001Male sex
0.92(0.86–0.98)
P < 0.001Donor age ≥40 years
0.79(0.72–0.86)
P < 0.001Observational data: associations, not effects.
Further findings
Rate of subsequent transfusion (transfusion burden)
| Adjusted rate ratio (95% CI) | ||
|---|---|---|
| PR | 1.05 (1.02–1.07) | |
| PAS | 1.44 (1.40–1.47) | |
| Storage 4 to <5 days | 1.11 (1.09–1.13) | |
| Storage ≥5 days | 1.28 (1.26–1.30) | |
| Donor age 40 to <60 years | 1.15 (1.13–1.17) | |
| Donor age ≥60 years | 1.10 (1.08–1.12) | |
| 0.512Adjusted rate ratio (log scale) |
| Outcome | Values | P value |
|---|---|---|
| Pretransfusion platelet countNeonates vs Older children | Neonates median 34 (IQR 20-54 × 103/µL) × 103/µL · Older children median 22 (IQR 11-40 × 103/µL) × 103/µL | P < 0.001 |
| Transfusions at pretransfusion count >25 (neonates) or >10 × 103/µL (older children), excluding bleeding | Neonates 67.8% · Older children 81.0% | |
| Platelet dose | Neonates median 14.9 mL/kg · Older children median 9.6 mL/kg | |
| Platelet transfusion rate by age1 to <6 years vs <1 year | <1 year 2.6% · 1 to <6 years 4.7% | P < 0.001 |
Hospital LOS and mortality
- These factors were not associated with hospital LOS or mortality
Original publication
Platelet Transfusion Practices and Outcomes in Neonates and Children. JAMA Netw Open. Published 2 January 2026. doi:10.
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