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Research Article
Determinants and transfusion practices in pediatric critical care unit: A prospective study in thrombocytopenic children
1 MD, MBA, Head, Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute, A-4, Paschim Vihar, New Delhi, India
2 MD, Head, Pediatric Intensive Care Unit, Sri Balaji Action Medical Institute, A-4, Paschim Vihar, New Delhi, India
3 DNB, Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute, A-4, Paschim Vihar, New Delhi, India
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Sadhana Mangwana
Department of Transfusion Medicine and Immunohematology, Sri Balaji Action Medical Institute, A-4, Paschim Vihar, New Delhi 110063,
India
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Article ID: 100012P05SM2021
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Mangwana S, Sharma PK, Lavanya B. Determinants and transfusion practices in pediatric critical care unit: A prospective study in thrombocytopenic children. Edorium J Pediatr 2021;5:100012P05SM2021.ABSTRACT
Aims: To evaluate incidence of thrombocytopenia, transfusion requirement, outcome, and prognostic value of platelet count. Prevalence of thrombocytopenia varies in various Intensive Care Units, ranging from 13% to 58% depending on disease profile of patients. Platelet count is considered a predictor of outcome. Restrictive transfusion policies save transfusion recipients from inherent risks of transfusion adverse reactions.
Methods: Prospective study was conducted over 15 months. Total 450 children of age >1 month and < 18 years in Pediatric Intensive Care Unit and High Dependency Unit were included. Patients’ complaints, complications, laboratory data, length of stay, severity score, transfusion requirement, and outcome were recorded.
Results: Patients’ age ranged from 4 months to 15 years with male preponderance. Incidence of thrombocytopenia was 24%. Fever, shock, and bleeding manifestations were found in 70.44%, 5.77%, and 9.11% cases, respectively; more in thrombocytopenia patients. Circulatory failure and shock were found in 17.59% thrombocytopenic patients vs. 2.04% cases in non-thrombocytopenic patients. Single- and multi-organ failure were more in thrombocytopenia patients (34.25% and 12.96%, respectively). 99.89% patients were discharged. Mortality rate of 3.7% in thrombocytopenia against 0.29% in non-thrombocytopenia patients support that thrombocytopenia is a good prognostic indicator for outcome. 4.44% patients required transfusion. 2.77% thrombocytopenia patients required multiple component transfusion and 0.92% cases only platelet transfusion; reinforcing conservative transfusion policies.
Conclusion: Thrombocytopenia is identified as prognostic indicator and major factor for bleeding and mortality in critically ill patients. It is concluded that restrictive strategy for platelet transfusions is safe and patients should be treated for underlying causes and monitored closely. There is need to define pediatric platelet transfusion thresholds for various clinical settings.
Keywords: Organ failure, Outcome, Platelet, Prism score, Thrombocytopenia, Thrombocytopenia associated multi organ failure (TAMOF), Transfusion, Viral markers
SUPPORTING INFORMATION
Author Contributions
Sadhana Mangwana - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Pradeep Kumar Sharma - Substantial contributions to conception and design, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Bandaru Lavanya - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Sadhana Mangwana et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
