PB0620 - The threshold for prophylactic platelet transfusion in pediatric patients with thrombocytopenia at Chiang Mai University

Background: Thrombocytopenia is commonly found in hospitalized children. Prophylactic platelet transfusion is one of the managements to prevent bleeding in hospitalized children. However, the proper threshold of platelet count (PLT) to start prophylactic platelet transfusion in hospitalized children is still unclear.

Aims: The aim of this study was to compare the bleeding events and complications of prophylactic platelet transfusion in hospitalized children with the thresholds of PLT < 20,000/µL versus < 10,000 /µL.

Methods: This retrospective chart-review study was conducted in hospitalized patients aged between 1 month and 16 years who was admitted at Chiang Mai University hospital from Jan 2021 to December 2022, required prophylactic platelet transfusion with the threshold of PLT at either < 20,000/µL (group A) or < 10,000 /µL (group B). Patients with active bleeding or underwent procedure or surgery within 1 week were excluded. Statistical significance was accepted when P < 0.05.

Results: We enrolled 580 events of prophylactic platelet transfusion. The median ages of patients were 7 years in both groups and almost 40% are female. The median PLTs (IQR) in group A and B were 15,000/µL (12,000-17,000) and 6,000 (4,000-8,000), respectively. There was no major bleeding in both group but clinically non-significant bleeding was significantly higher in group B than group A (36.3% versus 21.5%, P< 0.01). Febrile non-hemolytic transfusion reaction (29.7% versus 26.6%, P=0.46) and allergic skin reaction post transfusion (56.9% versus 55.6%, P=0.08) were not different between both groups. In addition, the mortality rates were not different between both groups.

Conclusion(s): Although lower PLT threshold at < 10,000//µL for prophylactic platelet transfusion caused higher clinically non-significant bleeding in this study, the major bleeding and mortality rate were not different. Therefore, PLT at < 10,000//µL can be accepted as the threshold for prophylactic platelet transfusion in hospitalized children.