Neonatal thrombocytopenia affects 20 -35% of neonates, many of them receive platelet transfusions. However, the level of platelets that would prevent bleeding and the efficacy of platelets transfusion in thrombocytopenic neonates has not been established. Consequently, guidelines for platelet transfusion are based on personal experience rather than on evidence based data.
We hypothesized a wide range of product selection and indications for transfusion among neonatologists in Israel. This study examines these parameters.
All 25 neonatal units (100% response rate) filled electronic questionnaires, addressing the choice of platelet products and the threshold platelet count for transfusion in different clinical settings.
Most neonatology units tend to infuse platelets within the framework of some guidelines. However, there is a considerable diversity in the products used and the thresholds for transfusion; fourteen departments consistently used leuco-reduced and irradiated platelets. Five only used irradiated platelets and 2 only leuco-reduced platelets.
Threshold selection was deviated in both directions; 30,000 to 50,000 were used as thresholds in term uncomplicated infants (56%), 150,000 for active bleeding in non stable infants (8%), and 10,000 platelets was used in certain clinical situations, while most guidelines use the threshold of 20,000.
We conclude that there is a considerable deviation from guidelines in choosing platelet products and thresholds for platelet transfusion in the neonatal period in Israel. As a result, a committee of neonatologists and pediatric hematologists is being established to decide on a mutually agreed policy to prevent under and over transfusions in neonates.
