An improvement project standardizing low prophylactic platelet transfusion dosing for infants.

BACKGROUND

Platelet transfusions are frequently given to preterm infants to prevent bleeding, but randomized trials demonstrated harmful effects from current practices.

PROBLEM

Many platelet transfusions were administered in 15-20 mL/kg doses.

METHODS

We sought to decrease platelet exposure among neonates by standardizing 10 mL/kg transfusions for non-bleeding thrombocytopenic infants in a level IV NICU.

INTERVENTIONS

We created evidence-based platelet dosing guidelines and changed practices in 3 plan-do-study-act cycles focused on education, reinforcement and electronic clinical decision support.

RESULTS

We reviewed 240 transfusions over 3 years. The percentage of 10 mL/kg transfusions improved from 17.6% to 100%, without increasing major bleeding and repeat transfusion rates. Monthly transfused platelet volumes decreased from 2269 ± 334 mL to 857 ± 181 mL (p < 0.001), conserving limited platelet resources and saving $2746-$4942 per month in platelets.

CONCLUSIONS

This study improved our platelet transfusion practices and can facilitate similar transfusion guideline adoption to benefit neonates at other institutions.