Development and implementation of restrictive platelet transfusion thresholds in a neonatal intensive care unit

Objective: Thrombocytopenia is a common problem affecting preterm neonates. Recent studies show increased morbidity and mortality with liberal platelet transfusion thresholds. We sought to standardize thrombocytopenia management through a transfusion guideline to reduce excessive transfusions. Study design: We developed and implemented a guideline using PDSA cycles for infants with birth weights <1000 grams. Platelet transfusions were classified as indicated or non-indicated per the guideline. Severe (grade 3 or 4) intraventricular hemorrhage and pulmonary hemorrhage rates were balancing measures. Results: We analyzed 101 infants pre-guideline and 96 infants post-guideline. The mean monthly non-indicated transfusions significantly decreased from 13.0 to 2.0, respectively (p-value < 0.01). Incidence of severe grade IVH and pulmonary hemorrhage remained stable. Conclusion: Rapid implementation of an evidence-based, restrictive platelet transfusion guideline significantly reduced non-indicated platelet transfusions without a concomitant increase in major bleeding events.