Objectives: To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. Design: Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. Setting: Eighty-two PICUs in 16 countries. Patients: Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. Interventions: None. Measurements and Main Results: Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 109 cells/L (8-68 × 109 cells/L), for transfusions with major incompatibility 26 × 109 cells/L (7-74 × 109 cells/L), and for transfusions with minor incompatibility 54 × 109 cells/L (14-81 × 109 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). Conclusions: No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
Bibliographical noteFunding Information:
1Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyte-rian Hospital – Weill Cornell Medicine, New York, NY. 2Division of Transfusion Medicine, Department of Pathology, Johns Hop-kins University, Baltimore, MD. 3Simmons Cancer Institute at SIU School of Medicine, Springfield, IL. 4Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Richmond at VCU, Richmond, VA. 5Department of Pathology – Weill Cornell Medicine, New York, NY. 6Paediatric Intensive Care Unit, Department of Pediatrics, Bristol Royal Hospital for Children, Bristol, United Kingdom. 7Divisions of Pediatric Critical Care and Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN. 8Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada. 9Transfusion Medicine, NHS Blood and Transplant, Oxford, United Kingdom. 10Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom. 11Radcliffe Department of Medicine, University of Oxford, and Oxford BRC Haematology Theme, Oxford United Kingdom. 12Department of Pediatrics, Division Critical Care, Washington University in St Louis, St Louis, MO. P3T Investigators are listed in the Acknowledgments. Supported, in part, by funds from the Clinical Translational Science Center, National Center for Advancing Translational Sciences grant number UL1-TR000457. Drs. Cushing and Spinella received funding from Cerus Corporation. The
Supported, in part, by funds from the Clinical Translational Science Center, National Center for Advancing Translational Sciences grant number UL1-TR000457.
© 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
- ABO compatibility
- critical illness
- platelet transfusion