The impact of evaluating platelet transfusion need by platelet mass index on reducing the unnecessary transfusions in newborns

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children

Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis has not been previously reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data from 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55-0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59-0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies should be performed to assess its clinical value.

What Laboratory Tests and Physiologic Triggers Should Guide the Decision to Administer a Platelet or Plasma Transfusion in Critically Ill Children and What Product Attributes Are Optimal to Guide Specific Product Selection? From the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding

OBJECTIVES

To present consensus statements and supporting literature for plasma and platelet product variables and related laboratory testing for transfusions in general critically ill children from the Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding.

DESIGN

Systematic review and consensus conference of international, multidisciplinary experts in platelet and plasma transfusion management of critically ill children.

SETTING

Not applicable.

PATIENTS

Critically ill pediatric patients at risk of bleeding and receiving plasma and/or platelet transfusions.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

A panel of 10 experts developed evidence-based and, when evidence was insufficient, expert-based statements for laboratory testing and blood product attributes for platelet and plasma transfusions. These statements were reviewed and ratified by the 29 Transfusion and Anemia EXpertise Initiative - Control/Avoidance of Bleeding experts. A systematic review was conducted using MEDLINE, EMBASE, and Cochrane Library databases, from inception to December 2020. Consensus was obtained using the Research and Development/University of California, Los Angeles Appropriateness Method. Results were summarized using the Grading of Recommendations Assessment, Development, and Evaluation method. We developed five expert consensus statements and two recommendations in answer to two questions: what laboratory tests and physiologic triggers should guide the decision to administer a platelet or plasma transfusion in critically ill children; and what product attributes are optimal to guide specific product selection?

CONCLUSIONS

The Transfusion and Anemia EXpertise Initiative-Control/Avoidance of Bleeding program provides some guidance and expert consensus for the laboratory and blood product attributes used for decision-making for plasma and platelet transfusions in critically ill pediatric patients.

Neonatal Thrombocytopenia and the Role of the Platelet Mass Index in Platelet Transfusion in the Neonatal Intensive Care Unit

Background

Neonatal thrombocytopenia is a common hematological abnormality that occurs in 20–35% of all newborns in the neonatal intensive care unit. Platelet transfusion is the only known treatment; however, it is the critical point to identify neonates who are really at risk of bleeding and benefit from platelet transfusion as it also has various potential harmful effects.

Aims

To investigate the prevalence and risk factors of neonatal thrombocytopenia and its relationship to intraventricular hemorrhage in the neonatal intensive care unit and to determine whether the use of platelet mass index-based criteria could reduce the rate of platelet transfusion.

Study Design

Retrospective cohort study.

Methods

This study was conducted in the neonatal intensive care unit of a tertiary university hospital. The medical records of neonates in the neonatal intensive care unit with platelet counts <150×10⁹/L between January 2013 and July 2016 were analyzed.

Results

During the study period, 2,667 patients were admitted to the neonatal intensive care unit, and 395 (14%) had thrombocytopenia during hospitalization. The rate of intraventricular hemorrhage was 7.3%. Multiple logistic regression analysis showed that although lower platelet counts were associated with a higher intraventricular hemorrhage rate, the effects of respiratory distress syndrome, sepsis, and patent ductus arteriosus were more prominent than the degree of thrombocytopenia. Thirty patients (7%) received platelet transfusion, and these patients showed a significantly higher mortality rate than their non-platelet transfusion counterparts (p<0.001). In addition, it was found that the use of platelet mass index-based criteria for platelet transfusion in our patients would reduce the rate of platelet transfusion by 9.5% (2/21).

Conclusion

Neonatal thrombocytopenia is usually mild and often resolves without treatment. As platelet transfusion is associated with an increased mortality rate, its risks and benefits should be weighed carefully. The use of platelet mass index-based criteria may reduce platelet transfusion rates in the neonatal intensive care unit, but additional data from prospective studies are required.

Influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in the prematurity

BACKGROUND

This study aims at evaluating the influence of platelet count, platelet mass index, and platelet function on the spontaneous closure of ductus arteriosus in prematurity.

METHODS

All preterm babies were divided into two groups, including Group 1 with "open PDA" and Group 2 with "closed PDA". The variables of platelet count, mean platelet volume, platelet mass index, and platelet function were analyzed and compared between two groups of patients to identify the factors that significantly influenced spontaneous closure of ductus arteriosus.

RESULTS

Twenty-four patients were in the "open PDA" group, whereas 36 patients were in the "closed PDA" group. Mean GA and BW were 27.6 ± 1.8 (23.1-30.4) and 28 ± 1.6 (23.4-30.6) weeks and 1009 ± 270 (585-1480) g and 1035 ± 298 (505-1500) g in "open PDA" and "closed PDA" groups, respectively (p > 0.05). The incidence of "Collagen-ADP > 130 s" was significantly higher in the "open PDA" group, and the levels of hemoglobin and hematocrit were significantly lower in the "open PDA" group (p < 0.05). Multivariate logistic regression analysis showed that respiratory distress syndrome (OR: 9, CI: 1.5-51.8) and collagen-ADP > 130 s (OR: 5.7 CI: 1.55-21.3) are two independent factors associated with ductal patency.

CONCLUSION

This is the first study in the English literature providing evidence of the influence of platelet dysfunction on the spontaneous closure of ductus arteriosus in prematurity. Longer collagen-ADP duration is identified as a risk factor of ductal closure.

Platelet mass index is increased in psoriasis. A possible link between psoriasis and atherosclerosis

INTRODUCTION

Psoriasis, whose relation with atherosclerosis etc. has long been known, is a chronic inflammatory disease. Besides providing hemostasis, platelets play important roles in inflammatory reactions and immune responses and contribute to endothelial damage, thus leading to atherosclerotic plaque formation. Mean platelet volume (MPV) has been previously reported as a platelet activation marker. Platelet mass index (PMI) is also related to platelet functionality and is thought to be a useful parameter for plaque formation capacity of platelets.

MATERIAL AND METHODS

Sex, age, age of onset, disease duration, family history, psoriasis area severity index, nail and joint involvement, platelet count, mean platelet volume, platelet mass index, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of 320 patients with psoriasis and 200 healthy persons were evaluated.

RESULTS

Mean platelet counts were 277.7 ±73.374 and 265.06 ±59.682 (p = 0.032); MPV values were 8.248 ±1.150 and 7.442 ±1.626 (p < 0.001); and PMI values were 2259 ±545.617 and 1964 ±622.762 (p < 0.001) respectively in the psoriasis and control group. The MPV showed a significant but inverse correlation with hs-CRP (p = 0.047, r = -0.149), and no correlation with ESR (p > 0.05). Platelet count and PMI had a significant and positive correlation with ESR (p < 0.001, r = 0.404 and p < 0.001, r = 0.371), but had no correlation with hs-CRP (p > 0.05).

CONCLUSIONS

Higher PMI and MPV values, which mean higher plaque formation capacity and more active platelets, in psoriasis may make psoriasis patients more sensitive to atherosclerotic plaque formation and complications. On the other hand, because of the positive PMI correlation with ESR (MPV had no correlation with ESR and had a negative correlation with CRP), PMI may be a better predictor of inflammation than MPV in psoriasis.

Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?

OBJECTIVE

Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants.

METHODS

This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n = 330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test.

RESULT

Among VLBW neonates, PMI values were lower in infants with ROP (p = 0.016), BPD (p = 0.002), IVH (p = 0.018) and NEC (p = 0.011) when compared with the control group in the second measurement.

CONCLUSIONS

In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.

Platelet mass index: is it a hope for reduction of platelet transfusion in NICU?

OBJECTIVE

Thrombocytopenia is a very common problem in neonatal intensive care unit whose only specific treatment is platelet (PLT) transfusion which has well-known risks. Our aim is to test whether using PLT mass-based transfusion guideline would result in fewer transfusions or not.

METHODS

One hundred neonates with PLT count <100,000/μl were randomized into two groups: Group 1 (n = 50) was transfused according to PLT count-based guideline, whereas Group 2 (n = 50) was transfused according to PLT mass-based guideline. Subjects receiving one or more PLT transfusions and total number of PLT transfusions, hemorrhages, morbidity and mortality in both groups were recorded.

RESULTS

Demographic characteristics, PLT counts of the infants and clinical conditions associated with thrombocytopenia in both groups were not different. There was no reduction in the number of subjects receiving PLT transfusions (54% in Group 1, 50% in Group 2; p = 0.69) and in the number of PLT transfusions per infant (0.82 ± 1.13 versus 0.8 ± 1.23; p = 0.95). There was also no difference with respect to bleeding, morbidity and mortality between the groups.

CONCLUSION

Transfusion according to PLT mass or PLT count-based guideline does not seem to influence number of transfusions or the number of infants who were transfused.