Does a restrictive platelet transfusion strategy affect red blood cell transfusion practice in children?

ABSTRACT

Background/Case Studies The coronavirus disease 2019 (COVID-19) pandemic has adversely affected the national blood supply by decreasing blood donations relative to ongoing patient transfusion needs, especially platelet concentrates. Given the decreased availability of platelet units for transfusions, blood banks may be forced on occasion to triage orders by either releasing a decreased quantity of platelets for a single transfusion event or to cancel orders, as appropriate. We investigated whether this restrictive platelet transfusion strategy caused any changes in red blood cell (RBC) transfusion practices. Study Design/Methods: We implemented a starting in early June 2020 and continuing to the present in our pediatric hospital setting. For this study, we compared platelet and red blood cells utilization between September 1, 2019 to June 1, 2020 (PRE) period, and June 1, 2020 to March 1, 2021 (POST) period in relation to the number of times a patient received a blood type and antibody screening test (TS). We also assessed administered 2 to 24 hours following an index platelet transfusion as a surrogate marker for estimating hemostatic efficacy. In addition, average volume of transfused RBCs for each patient during both time intervals were compared. Proportions were compared using z-test and means were compared using t-test (R version 3.6.3). Results/Findings: TS to platelet and TS to RBC transfusion rates were higher in the PRE cohort than the POST cohort (13.79% vs 12.45%, p<0.001 and 23.61% vs 20.61%, p<0.001). In the PRE cohort there were 876 RBC transfusions in the subsequent 24-hour period compared to 698 in the POST cohort. No significant difference was observed in time-to-RBC-transfusions (12.85 h vs 12.35 h, p=0.110). However, the average volume of transfused RBCs that each patient received showed an increase in the POST cohort, compared to the PRE cohort (182 mL vs. 209 mL, p<0.001). Conclusions: For pediatric patients, the restrictive platelet transfusion strategy resulted in lower rates of TS to RBC and TS to platelet transfusion, however, there was an increase in the average volume of RBCs each patient was transfused with. Following a platelet transfusion, there was no statistically significant change in time to RBC transfusions between the two practices. This finding was indicative of the absence of early significant bleeding episodes resulting from a restrictive platelet transfusion strategy.