LAUSR

There is little consensus on the indications for platelet transfusions in neonates with thrombocytopenia. A multicentre European trial randomised infants <34 weeks’ gestation at birth to receive platelet transfusions if their platelet count fell below either 50 000/mm (high threshold) or 25 000/mm (low threshold). The primary outcome was death or new major bleeding within 28 days. Babies in the high-threshold group were more likely to need a platelet transfusion (296 of 328, 90%) than those in the low-threshold group (177 of 331, 53%). Death or a new major bleed occurred significantly more often in the high(26%) than the low(19%) threshold groups (odds ratio 1.57; 95% confidence interval 1.06–2.32, P = 0.02), suggesting platelet transfusions may be harmful. The major effect was on mortality (15 vs. 10%). Platelet transfusions have been shown to be deleterious in adults with intracranial bleeding associated with anti-platelet agents and in adults with platelet-consumptive disorders, perhaps due to immune dysregulation. Platelet transfusions are potentially risky and should be used carefully on the basis of best available evidence.