Comparison of continuous to bolus platelet infusion in pediatric patients refractory to platelet transfusion Academic Article uri icon

Overview

MeSH Major

  • Delirium
  • Intensive Care Units, Pediatric
  • Mass Screening

abstract

  • Introduction: We conducted a randomized controlled trial of continuous vs. bolus infusion of platelets in refractory thrombocytopenic pediatric patients (defined by corrected count increment (CCI)). CCI=((post - pretransfusion platelet count) * body surface area) รท (# plts transfused). The purpose of the study is to evaluate whether continuous platelet transfusion confers better platelet increments or maintained platelet counts above a pre-determined threshold level better than bolus. Methods: Patients were deemed refractory to platelet transfusions if their CCI was less than 2500 at 12-24 hours post infusion, or CCI was less than 7500 at 15 minutes to 1 hour post-infusion on two prior occasions. 6 patients age 5 to 20 years in the PICU in an academic medical center received one single donor unit of platelets in two evenly split (and pre-counted) aliquots on separate occasions (when platelet counts dropped below the pre-determined threshold level). Data obtained from two of the patients was disqualified, because their aphereses were unevenly split. Patients were randomized to receive either the first transfusion over 1 hour (bolus) and the second over 4 hours (continuous) or the infusions in the reverse order. Platelet counts were followed until 6 hours post-infusion. Demographic and clinical data of the patients were also recorded. Results: All platelet counts remained above threshold with both methods of transfusion for the study duration. At 1 hour, the mean CCI's were 14,725 and 2804 respectively for bolus and continuous which is statistically significant by Wilcoxon rank sum test. The difference in CCI's for the platelet counts beyond 1 hour did not reach statistical significance. Moreover, the CCI's at 4 and 6 hours were very similar. Conclusions: Constant platelet infusion did not improve CCI's; nor was it better at keeping platelet count above a pre-determined threshold level in refractory thrombocytopenic patients. In fact, CCI's were better with the bolus infusions for the first hour. This study is ongoing and we anticipate enrolling more patients.

publication date

  • December 1999

Research

keywords

  • Academic Article

Additional Document Info

start page

  • A69

volume

  • 27

number

  • 12 SUPPL.