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

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

In a recent analysis of 40,779 platelet transfusions 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.1

HCPLive spoke with study investigator Ruchika Goel, MD, professor and associate vice chair of research at SIU School of Medicine, to glean key clinical takeaways from the findings.2

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.

References

1. Goel R, Karam O, Warden DE, et al. Platelet Transfusion Practices and Outcomes in Neonates and Children. JAMA Network Open. 2026;9(1):e2554531. doi:https://doi.org/10.1001/jamanetworkopen.2025.54531

2. 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

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