When Platelet Increments Matter, With Ruchika Goel, MD

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

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 HCPLive. “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.2

Methods

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.1

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.1

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.1

Results

Upon analysis of 40,779 platelet transfusion episodes, the median number per patient encounter was 2. 1

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.1

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.1

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]; P < .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.1

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]).1

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).1

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).1

“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.”

1. References
   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. 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/

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