LAUSR

OBJECTIVE A few patients in neonatal intensive care units (NICU) receive numerous platelet transfusions. These patients can become refractory, defined as transfusions of ≥10 mL/kg failing to increase the platelet count by at least 5000/µL. Causes of, and best treatments for, platelet transfusion refractoriness in neonates have not been defined. STUDY DESIGN Multi-NICU multi-year retrospective analysis of neonates receiving >25 platelet transfusions. RESULTS Eight neonates received 29 - 52 platelet transfusions. All eight were blood group O. Five had sepsis, four were very small for gestational age, four had bowel resections, two Noonan syndrome, two had cytomegalovirus infection. All eight had some (19 - 73%) refractory transfusions. Many (2 - 69%) of the transfusions were ordered when the platelet count was >50,000/µL. Higher post-transfusion counts occurred after ABO-identical transfusions (p=0.026). Three of the eight had late NICU deaths related to respiratory failure; all five survivors had severe bronchopulmonary dysplasia requiring tracheostomy for prolonged ventilator management. CONCLUSION Neonates who are high users of platelet transfusions appear to be at high risk for poor outcomes, especially respiratory failure. Future studies will examine whether group O neonates are more likely to develop refractoriness and whether certain neonates would have a higher magnitude of post-transfusion rise if they received ABO identical donor platelets.