Advances and controversies in neonatal ICU platelet transfusion practice.
Advances and controversies in neonatal ICU platelet transfusion practice.
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DOI：
10.1016/j.yapd.2008.07.003
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发表时间：
2008-01-01
影响因子：
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通讯作者：
Christensen, Robert D
中科院分区：
文献类型：
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作者：
Christensen, Robert D
目前给予新生儿重症监护病房患者的一些血小板输注是不必要的，也没有任何益处。虽然是出于良好的意愿，但不必要的血小板输注会带来已知和未知的风险。在新生儿重症监护病房中识别和消除任何不必要的血小板输注将是朝着更好的护理、更低的成本和更仔细地保存血液成分资源迈出的一步。如果要收集必要的数据来改善新生儿重症监护病房的血小板输注实践，就需要重新对血小板输注研究感兴趣。回顾性研究可能是有价值的：例如，寻找出血事件和血小板计数之间的联系可以提示因果关系的可能性。这样的研究可能会确定血小板计数的大致水平，传达高出血风险，并可能有助于关注未来的前瞻性试验。前瞻性间接研究也可能有价值，例如，测量模板出血时间和PFA-100关闭时间作为血小板计数的函数，可能作为循环血小板质量的函数，并将提供与血小板输血益处相关的新信息。这样的研究可能会更好地了解血小板计数在血小板栓形成受损之前可以降到多低。然而，似乎不可避免的是，需要新的、多中心的、随机的、前瞻性的研究，在这些研究中，NICU患者被分配不同的血小板输注触发因素，然后仔细跟踪出血事件和长期神经发育结果。只有这种类型的研究才有可能产生广泛实施改进新生儿重症监护病房血小板输注实践所需的证据基础。
Some of the platelet transfusions currently given to NICU patients are unnecessary and convey no benefits. Although ordered with good intentions, unnecessary platelet transfusions carry known and unknown risks. Identifying and eliminating any unnecessary platelet transfusions in NICUs would be a step toward better care, lower costs, and more careful preservation of blood component resources. A renewed interest in platelet transfusion studies is needed, if essential data is to be gathered to improve NICU platelet transfusion practice. Retrospective studies can be of value: for instance, seeking associations between bleeding events and platelet counts can suggest the possibility of cause and effect relationships. Such studies might identify approximate platelet count levels that convey high hemorrhagic risk and might help focus future prospective trials. Prospective indirect studies also can be of value, for instance, measuring the template bleeding time and the PFA-100 closure time as a function of platelet count and perhaps as a function of circulating platelet mass, and would provide new information with relevance to platelet transfusion benefits. Such studies might give a better awareness of how low the platelet count can fall before platelet plug formation is impaired. It seems inescapable, however, that new, multicentered, randomized, prospective studies are needed, where NICU patients are assigned different platelet transfusion triggers and then carefully tracked for bleeding events and long-term neurodevelopmental outcomes. Only that type of study is likely to generate the evidence base needed for widespread implementation of improvements in NICU platelet transfusion practice.