Platelet Transfusion Practices in the PICUs: Multicenter, Observational Study, in Türkiye and Northern Cyprus, 2024

OBJECTIVES: We aimed to describe the use of platelet transfusions among critically ill children managed in Türkiye in late 2024. Secondarily, we sought to determine these practices in relation to the 2022 Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB) recommendations for critically ill pediatric patients. DESIGN: Prospective study (October-December 2024). SETTING: 22 PICUs in Türkiye and Northern Cyprus. PATIENTS: Patients of 1 month to 18 years who received at least one platelet transfusion in the PICU. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Out of 2693 PICU admissions, 200 patients (7.4%) received 577 platelet transfusions. Of the transfusions, 383 of 577 transfusions (66.4%) were for prophylaxis, most frequently for isolated thrombocytopenia (194/383, 50.7%). Regarding the transfusion threshold for prophylaxis, in the 194 cases of isolated thrombocytopenia, the median (interquartile range [IQR]) pretransfusion platelet count was 24 (IQR, 16-38) × 109/L, which differed from the TAXI-CAB consensus statement guidance of less than 10 × 109/L. Platelet transfusion, as opposed to not, was associated with 20-fold greater odds of 28-day mortality (p < 0.001), and among the 200 patients receiving platelets, multivariable analysis showed that lower pretransfusion platelet count, support with invasive mechanical ventilation, and hospital-acquired infections collectively accounted for 34% of the variance in model performance for classifying 28-day mortality. CONCLUSIONS: Our 2024 national, multicenter PICU study across Türkiye and Northern Cyprus shows that around two-thirds of transfusion episodes were for prophylaxis, and multivariable logistic regression modeling identified patient factors associated with greater odds of 28-day mortality. The median pretransfusion threshold for isolated thrombocytopenia was around 20 × 109/L, which is double the less than 10 × 109/L in the 2022 TAXI-CAB consensus statement. Given the heterogeneity of critically ill patients and practice environments, understanding the reasons behind these practices may help inform future research and consensus recommendations.

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Journal
Pediatric Critical Care Medicine
Published
2026-11-04
DOI
https://doi.org/10.1097/pcc.0000000000004076
Primary Topic
Blood transfusion and management
Type
article
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article

Platelet Transfusion Practices in the PICUs: Multicenter, Observational Study, in Türkiye and Northern Cyprus, 2024

Nihal Akçay, Selçuk Sinan Çelik, Büşra Daştan İnce, Ayşe Aşık et al.
Pediatric Critical Care Medicine
Blood transfusion and management
article

Platelet Transfusion Practices in the PICUs: Multicenter, Observational Study, in Türkiye and Northern Cyprus, 2024

Nihal Akçay, Selçuk Sinan Çelik, Büşra Daştan İnce, Ayşe Aşık, Mehmet Alakaya, Hasan Ağın, Erennur Tufan, Damla Pınar Yavaş, Elif Akman, Murat Tanyıldız, Alper Köker, Ömer Özden, Hakan Tekgüç, Mutlu Uysal Yazıcı, Pınar Yazıcı, Muhammed Üdürgücü, Gökhan Ocakoğlu, Hatice Feray Arı, Ebru Azapağası, Sadık Kaya, Oğuz Dursun, Çağlar Ödek, Kübra Cebeci, Resul Yılmaz, Özden Özgür Horoz, Muhterem Duyu, Deniz Guven Karakurt, Didar Arslan, Sinan Yavuz, Abdullah Yazar, Abdullah Akkuş, Neslihan Zengın, Ali Korulmaz, Emrah Gün, Tanıl Kendirli, Faruk Ekıncı, Ayşen Durak Aslan, FEVZİ AYDOĞDU, MERVE MISIRLIOĞLU ÇELİK, Alper Oglakcioglu, Betül Demir Akyüz, Dinçer Yildizdaş, Mebrure Elanur Kortmaz, Ali Avci
article en

Abstract

OBJECTIVES: We aimed to describe the use of platelet transfusions among critically ill children managed in Türkiye in late 2024. Secondarily, we sought to determine these practices in relation to the 2022 Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB) recommendations for critically ill pediatric patients. DESIGN: Prospective study (October-December 2024). SETTING: 22 PICUs in Türkiye and Northern Cyprus. PATIENTS: Patients of 1 month to 18 years who received at least one platelet transfusion in the PICU. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Out of 2693 PICU admissions, 200 patients (7.4%) received 577 platelet transfusions. Of the transfusions, 383 of 577 transfusions (66.4%) were for prophylaxis, most frequently for isolated thrombocytopenia (194/383, 50.7%). Regarding the transfusion threshold for prophylaxis, in the 194 cases of isolated thrombocytopenia, the median (interquartile range [IQR]) pretransfusion platelet count was 24 (IQR, 16-38) × 109/L, which differed from the TAXI-CAB consensus statement guidance of less than 10 × 109/L. Platelet transfusion, as opposed to not, was associated with 20-fold greater odds of 28-day mortality (p < 0.001), and among the 200 patients receiving platelets, multivariable analysis showed that lower pretransfusion platelet count, support with invasive mechanical ventilation, and hospital-acquired infections collectively accounted for 34% of the variance in model performance for classifying 28-day mortality. CONCLUSIONS: Our 2024 national, multicenter PICU study across Türkiye and Northern Cyprus shows that around two-thirds of transfusion episodes were for prophylaxis, and multivariable logistic regression modeling identified patient factors associated with greater odds of 28-day mortality. The median pretransfusion threshold for isolated thrombocytopenia was around 20 × 109/L, which is double the less than 10 × 109/L in the 2022 TAXI-CAB consensus statement. Given the heterogeneity of critically ill patients and practice environments, understanding the reasons behind these practices may help inform future research and consensus recommendations.

Pediatric Critical Care Medicine
Bursa Uludağ Üni̇versi̇tesi̇ (TR), Izmir University (TR), Koç University (TR), Selçuk University (TR), Ankara University (TR), Manisa Celal Bayar University (TR), Akdeniz University (TR), Ondokuz Mayıs University (TR), Ege University (TR), Gülhane Askerî Tıp Akademisi (TR), Dr. Behçet Uz Çocuk Hastalıkları Hastanesi (TR), Memorial Ankara Hospital (TR), Necmettin Erbakan University (TR), Sağlık Bilimleri Üniversitesi (TR), İstanbul Kanuni Sultan Süleyman Eğitim ve Araştırma Hastanesi (TR), Ankara Bilkent City Hospital (TR), Mersin Üniversitesi (TR), Kocaeli Üniversitesi (TR), Cukurova University (TR), Adnan Menderes University (TR), Gazi University (TR)
Openalex Percentile: Top 16%
Blood transfusion and management
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