Ruchika Goel, MD, is a professor and associate vice chair of research at SIU School of Medicine.

Ruchika Goel, MD

Defining the goal of platelet transfusion, prevention or treatment, may be as important as the platelet count itself.

in neonates and older children, reduced platelet increment (PI) did not lead to worse clinical outcomes, suggesting that this marker does not precipitate an increased, automatic need for transfusion.

, professor and associate vice chair of research at SIU School of Medicine, to glean key clinical takeaways from the findings.

How should clinicians and Transfusion services think about balancing transfusion safety measures with platelet effectiveness and pediatric care?

That’s an excellent question, and I want to emphasize it overall by rechecking: what is our goal? Number one, is it prevention of bleeding in an otherwise stable patient, or in an actively bleeding patient, or a high-risk patient? Is it hemostasis? Are you trying to do bleeding control?

So reassessing what our goal is and not mixing the two is very important. Looking for any other non–product-related causes of poor increment is also important. For example, any reason for high platelet consumption, infection, inflammation, DIC, splenic sequestration, medications, or any other reasons. For example, a patient being on ECMO—these are other reasons where you could have poor increment causes, and they need to be reassessed.

If there are further transfusions, consider looking at the overall clinical situation and assessing the requirement. That should be the decision-making criteria, not simply a suboptimal increment in a platelet count.

Do your findings suggest that we need to rethink what defines successful platelet transfusion in children beyond simply achieving a target platelet count?

Yes, I think this study emphasizes that, as well as the accompanying editorial by Dr Megan Delaney. They really push toward redefining what we call a successful platelet transfusion, really being beyond hitting a target platelet count, a more clinically meaningful definition of what we are trying to achieve.

For example, what I would say a successful platelet transfusion would be is something that achieves the intended clinical objective, whether it’s prophylaxis of bleeding or attempted bleeding control, while we have minimal transfusion burden. So optimizing our overall transfusion burden and making sure we have no or minimal transfusion-related harm while our overall clinical objective is met, and not using a specific number or an increment as our goal of a successful platelet transfusion.

So in practice, that would mean understanding our endpoints, such as hemostatic readiness, bleeding events, transfusion reactions and complications, and the overall transfusion burden. These are the factors that need to be taken into account as what we call a successful platelet transfusion.

What are the limitations to this study and how should clinicians interpret them?

The only thing I’d like to add is that readers should go in detail with the study limitations as well. This is a very large, very unique database, and there are very few such powerful databases that can assess the donor as well as the product and ultimately link it to clinical outcomes in the recipient. So there are several strengths, but there are also several limitations.

Ultimately, it is an electronic health record–driven result. We have highlighted several limitations of the study, and we do want to emphasize that there is a need for more prospective studies and perhaps a need for continued randomized controlled trials to study several clinical outcomes.

So while we address several strengths of the study, I want to redirect the reader to look at the limitations of the study and incorporate those into what they can do in their routine clinical practice, which should be evidence-based.

Goel R, Karam O, Warden DE, et al. Platelet Transfusion Practices and Outcomes in Neonates and Children. 

https://doi.org/10.1001/jamanetworkopen.2025.54531

Goel R. When Platelet Increments Matter, With Ruchika Goel, MD. Hcplive.com. Published February 13, 2026. Accessed February 14, 2026. 

https://www.hcplive.com/view/when-platelet-increments-matter-with-ruchika-goel-md

Articles

In pediatric platelet transfusions, what counts as success depends on the clinical context and treatment goals, not just the platelet count.

Rethinking What Defines Success in Pediatric Platelet Transfusion, With Ruchika Goel, MD

In addition to these findings, study investigators draw attention to data that 3.6% of neonates and older children had ≥1 platelet transfusion, highlighting the importance of critically assessing transfusion practices in this population.

“From a clinical perspective, we need to assess our adherence to the platelet transfusion guidelines and also the marker, post-transfusion platelet increment. It may be an imperfect surrogate for looking at patient-centred outcomes,” said Ruchika Goel, MD, professor and associate vice chair of research at SIU School of Medicine, in an interview with 

 “For example, if you're giving platelets as prophylaxis to prevent bleeding or as therapy to treat bleeding. From a clinician's lens, this study points to judging your effectiveness by the clinical context and the overall bleeding risk, and not just by the platelet count increment or the bump alone.”

Transfusions are the only available treatment to raise platelet counts in thrombocytopenic infants, aiming to stop or prevent bleeding. While they can prevent bleeding, platelet transfusions are associated with increased inflammation and can sometimes increase mortality or morbidity in neonates.

Goel and colleagues defined a platelet transfusion event as the issue of a platelet product by the transfusion service within the encounter start and end times. They calculated transfusion incidence as a binomial proportion of encounters during which ≥1 platelet product was issued, for the total population and by patient sex, age, and self-reported race and ethnicity.

The cohort study involved data on 249,340 inpatient encounters from 7 blood centers and 22 hospitals collected by the ​​Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric. The included patients were 0 to < 18 years of age. Investigators defined neonates as those < 28 days of age, and patients were otherwise considered older children.

Goel and colleagues observed ≥1 platelet transfusion in 3.6% of the study population (n = 8874). Of these, 3.3% were female, 3.7% were male, and the average age was 2.5 years, with a median weight of 1.6 kg.

Upon analysis of 40,779 platelet transfusion episodes, the median number per patient encounter was 2. 

In neonates, 32.2% of platelet transfusions were given at pretransfusion platelet counts < 25 × 103/µL, the remaining were given at increased pretransfusion platelet counts, including 38.5% at >25-50 × 103/µL, 19.6% at >50-100 × 103/µL, and 9.7% at >100 × 103/µL. The median transfusion dose was 14.9 mL/kg.

In older children, investigators analysed 26,570 transfusion events, with 19.0% of platelet transfusions given at pretransfusion platelet counts < 10 × 103/µL and the remaining were at higher pretransfusion platelet counts, including 3.0% at >100 × 103/µL. The median transfusion dose was 9.6 mL/kg.

Overall, investigators saw significantly elevated pretransfusion platelet count in neonates (34 × 103/µL [20-54 × 103/µL] compared with older patients (22 × 103/µL [11-40 × 103/µL]; 

 < .001). Post-transfusion PI was highest for pretransfusion platelet counts < 25 × 103/µL and decreased for higher counts, becoming negative (median, −25 × 103/µL for counts > 100 × 103/µL. Similarly, among infants and older children, PIs were highest for counts <10 × 103/µL and decreased for higher counts, becoming negative (median, −22 × 103/µL) for counts > 100 × 103/µL.

Platelet components stored in PAS had reduced odds of posttransfusion PI higher than 15 × 103/µL compared with platelet components not stored in PAS (adjusted Odds Ratio [AOR], 0.32 [95% CI, 0.27-0.37). Platelet storage > 3 days) was associated with decreased odds of PI > 15 × 103/µL (AOR, 0.67; 95% CI, 0.58-0.76 to 0.82; 95% CI, 0.76-0.88). Pathogen-reduced platelet components were associated with lower odds of achieving an increment higher than 15 × 103/µL (AOR, 0.82 [95% CI, 0.73-0.92]).

Assessing donor factors, investigators observed male sex was associated with reduced odds (AOR, 0.92; 95% CI, 0.86-0.98) of posttransfusion PI >15 × 103/µL per transfusion event. Additionally, donor age of ≥ 40 years compared with donor age 25 to < 40 years was independently associated with reduced odds of a PI >15 × 103/µL platelet increment (AOR, 0.79; 95% CI, 0.72-0.86).

In multivariable analysis, no donor or platelet characteristics were associated with a difference in risk of hospital discharge after 7 days (Adjusted Rates Ratio [ARR], 1.03; 95% Confidence Interval [CI], 0.89-1.20] for PR). Further, the rate of mortality was unchanged among platelet characteristics after an offset for the hospital length of stay of the encounter (ARR, 0.66 [95% CI, 0.42-1.04] for PR).

“A lower platelet increment should not automatically be used as a marker to lead to higher need for transfusion or, hence, an increased transfusion burden, because we are not necessarily seeing these to be related to clinical outcomes.”

References
Goel R, Karam O, Warden DE, et al. Platelet Transfusion Practices and Outcomes in Neonates and Children. 

Neonatal Platelet Transfusions See Increased Inflammation, Not Reduced Bleeding. Hematology Advisor. Published November 25, 2025. Accessed February 12, 2026. 

https://www.hematologyadvisor.com/news/neonatal-platelet-transfusion-inflammation-bleeding-treatment-risk/

Podcasts

Low post-transfusion platelet increments did not predict mortality or length of stay in pediatric patients.