Comparison of continuous to bolus platelet infusion in pediatric patients refractory to platelet transfusion
Intensive Care Units, Pediatric
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) ÷ (# 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.