Temporal Trends in Red Blood Cell and Platelet Transfusion Thresholds for Extremely Low Birth Weight Infants

Ravi M. Patel, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA. Electronic address: rmpatel@emory.edu.
Jeanne E. Hendrickson, Department of Pathology and Laboratory Medicine, Center for Transfusion and Cellular Therapies, Emory University School of Medicine, Atlanta, GA; Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT. Electronic address: jeanne.hendrickson@emory.edu.
Rebecca Birch, Westat, Rockville, MD. Electronic address: rebeccabirch@westat.com.
Daniel W. Bougie, Versiti Blood Research Institute, Milwaukee, WI. Electronic address: dwbougie@Versiti.org.
Brian Branchford, Versiti Medical Sciences Institute and Blood Research Institute, Medical College of Wisconsin, and Children's Wisconsin, Milwaukee, WI. Electronic address: bbranchford@Versiti.org.
Xuxin Chen, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY. Electronic address: xc2663@cumc.columbia.edu.
Brian Custer, Vitalant Research Institute, San Francisco, CA; Department of Laboratory Medicine, University of California, San Francisco, CA. Electronic address: BCuster@vitalant.org.
Robert A. Desimone, Department of Pathology, Weill Cornell Medicine, New York, NY. Electronic address: rod9096@med.cornell.edu.
Erika Edwards, Vermont Oxford Network, Burlington, VT. Electronic address: eedwards@VTOXFORD.org.
Ruchika Goel, Department of Internal Medicine, Simmons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL; Corporate Medical Affairs, Vitalant, Scottsdale, AZ; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: ruchikagoel1@gmail.com.
Jerome Gottschall, Versiti Blood Research Institute, Milwaukee, WI. Electronic address: jlgottschall@versiti.org.
Eldad A. Hod, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY. Electronic address: eh2217@cumc.columbia.edu.
Morvarid Moayeri, Department of Laboratory Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: Morvarid.Moayeri@ucsf.edu.
Oliver Karam, Department of Pediatrics, Pediatric Critical Care Medicine, Yale School of Medicine, New Haven, CT. Electronic address: oliver.karam@yale.edu.
Elizabeth F. Stone, Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY. Electronic address: es2024@cumc.columbia.edu.
Naomi L. Luban, Children's National Research Institute, Washington, DC, USA; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: nluban@childrensnational.org.
Cassandra D. Josephson, Johns Hopkins All Children's Hospital, Cancer and Blood Disorders Institute, St. Petersburg, FL; Johns Hopkins University School of Medicine, Departments of Oncology, Pediatrics, and Pathology Baltimore, MD. Electronic address: cjosep22@jhmi.edu.
Martha Sola-Visner, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: martha.sola-visner@childrens.harvard.edu.

Document Type

Journal Article

Publication Date

8-29-2025

Journal

The Journal of pediatrics

DOI

10.1016/j.jpeds.2025.114797

Keywords

Red blood cell; blood; infant; platelet; preterm; transfusion

Abstract

OBJECTIVE: To evaluate if hematologic thresholds for red blood cell (RBC) and platelet transfusions changed over time following publication of new evidence from randomized trials in a multicenter cohort of extremely low birth weight (ELBW) infants. STUDY DESIGN: We analyzed data from the National Heart Lung and Blood Institute Recipient Epidemiology and Donor Evaluation Study-IV-Pediatrics (REDS-IV-P) study from April 2019 through December 2023. We compared pre-transfusion hemoglobin and platelet counts closest to each transfusion within 24 hours by year using linear mixed models and used model interaction terms to determine if trends over time differed by postnatal weeks. RESULTS: We evaluated 981 ELBW infants. For trends in RBC transfusion thresholds, 785 infants (80%) received 5182 RBC transfusions, of which 4835 (93%) had a pre-transfusion hemoglobin value. Pre-transfusion hemoglobin declined over time (P<0.0001), with trends differing by postnatal week (interaction P=0.005). The greatest year-over-year decline in pre-transfusion hemoglobin was in the 3 postnatal week or later. For platelet transfusions, 221 infants (23%) received 934 platelet transfusions, of which 900 (96%) had a corresponding pre-transfusion platelet count. There was no change in pre-transfusion platelet count over time (P=0.24). These trends did not differ by postnatal week (interaction P=0.14), although pre-transfusion platelet counts were lower after the first postnatal week (P<0.001). CONCLUSIONS: In this cohort of US centers, we observed declines in pre-transfusion hemoglobin but not pre-transfusion platelet counts from 2019-2023. These findings suggest evidence from recent RBC and platelet transfusion threshold trials may have been differentially translated into clinical practice for ELBW infants.

Department

Pediatrics

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