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Are thrombocytopenia and platelet transfusions associated with major bleeding in preterm neonates? A systematic review

Sanquin Blood Supply Foundation, Department of Clinical Transfusion Medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands; Academic Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.. Electronic address: s.f.gunnink@amc.uva.nl. Erasmus Medical Center, Sophia Children's Hospital, Department of Pediatric Hematology, Wytemaweg 80, 3015 CN Rotterdam, the Netherlands. Electronic address: e.j.huisman@erasmusmc.nl. Sanquin Blood Supply Foundation, Department of Clinical Transfusion Medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands; Leiden University Medical Center, Department of Clinical Epidemiology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands.. Electronic address: J.G.van_der_Bom@lumc.nl. Sanquin Blood Supply Foundation, Department of Clinical Transfusion Medicine, Plesmanlaan 1A, 2333 BZ Leiden, the Netherlands. Electronic address: F.M.A.van_Hout@lumc.nl. Academic Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands. Electronic address: s.makineli@vumc.nl. Leiden University Medical Center, Willem Alexander Children's Hospital, Department of Neonatology, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. Electronic address: e.lopriore@lumc.nl. Academic Medical Center, Emma Children's Hospital, Department of Pediatric Hematology, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands. Electronic address: c.j.fijnvandraat@amc.uva.nl.

Blood Reviews. 2018
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Abstract
Over 75% of severely thrombocytopenic preterm neonates receive platelet transfusions to prevent bleeding, but transfusion guidelines are based mainly on expert opinion. The aim of this review was to investigate whether platelet counts or transfusions are associated with major bleeding in preterm neonates. We performed a systematic search of the EMBASE and MEDLINE databases until December 2017. We included randomized trials, cohort and case control studies. (Prospero: CRD42015013399). We screened 8734 abstracts and 1225 fulltexts, identifying 36 eligible studies. In 30, timing of the platelet counts or transfusions in relation to the bleeding was unclear. Of the remaining six studies, two showed that thrombocytopenia was associated with increased risk of bleeding, two showed no such assocation, and three showed lack of an association between platelet transfusions and bleeding risk. The study results suggest that prophylactic platelet transfusions may not reduce bleeding risk in preterm neonates.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine