Thrombocytopenia is a blood disorder characterized by abnormally low levels of thrombocytes, also known as platelets. Platelet transfusions are routinely used to prevent bleeding in neonates with thrombocytopenia, but the thresholds for platelet transfusions in preterm neonates are not well-known. The objective of this study is to determine platelet-transfusion thresholds in neonates with severe thrombocytopenia.

This multicenter, randomized trial included a total of 660 infants born at less than 34 weeks of gestation with severe thrombocytopenia. The infants were assigned to two groups: with platelet transfusion at platelet-count thresholds of 50,000 per cubic mm (high-threshold group, n=328) or 25,000 per cubic mm (low-threshold group, n=331). The primary endpoint of the study was death or major bleeding within 28 days of randomization.

296 infants (90%) in the high-threshold group and 177 infants (53%) in the low-threshold group received at least one platelet transfusion. A new major bleeding episode or death appeared in 85 infants (26%) in the high-threshold group and 61 infants (19%) in the low-threshold group. The rate of serious adverse events was similar in the two groups (25% vs. 22%).

The findings concluded that platelet transfusions at a platelet-count threshold of 50,000 per cubic mm resulted in a higher rate of major bleeding and death than platelet transfusions at a platelet-count threshold of 25,000 per cubic mm.

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa1807320