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.