Premature infants are at an increased risk of intraventricular hemorrhage.
Underdeveloped subependymal matrix and diminished coagulation cascade lead
to subsequent rupture at the capillary level. Platelet levels should be kept at 100
x 10^9 in sick premature infants and at 50 x 10^9 in more stable patients [23].^ A
second area where children may benefit from increased platelet levels greater
than 100 x 10^9 is during ECMO. No standard guidelines exist and there is some
institutional variability in protocols. However, one should consider transfusion to
this level and possibly higher in the face of active bleeding [23]. Other clinical
scenarios should following guidelines and practical application that is seen in
adult patients.
Platelet Transfusion Guidelines:^24
Transfuse if:
- Stable premature infant with platelets < 50 x 10^9
- Sick Premature infant with platelets < 100 x 10^9
- Term infant < 4 months old with platelets < 20 x 10^9
- Term infants > 4 months old with platelets > 10 x 10^9
- Child scheduled for invasive procedure with platelet count < 50
x 10^9 - Active bleeding in patient with platelet count < 50 x 10^9
- Child on ECMO with platelet count < 100 x 10^9
- Bleeding in patient with qualitative platelet defect (ie ASA
therapy), regardless of the platelet count