Platelet transfusions are frequently given to neonatal intensive care unit (NICU) patients with severe
thrombocytopenia (platelets less than 50 x 10(9) L(-1)) but no study has assessed whether this is clinically appropriate. To address this we conducted a retrospective review of
platelet transfusion practice in patients developing severe
thrombocytopenia over 3 years in a single NICU. Out of 901 admissions, 53 (6%) developed severe
thrombocytopenia. Twenty-seven neonates received a total of 63
platelet transfusions, the main triggers being: platelet count less than 30 x 10(9) L(-1) (all patients), or less than 50 x 10(9) L(-1) in those with previous haemorrhage or clinical instability. No major haemorrhage occurred during severe
thrombocytopenia either in neonates in whom
platelet transfusions were withheld (26/53) or in neonates given platelets who survived to discharge (22/27). Five preterm neonates given platelets died but all had overwhelming
sepsis or
necrotizing enterocolitis and none died directly as a result of haemorrhage. Although the widely used liberal triggers for neonatal
platelet transfusion highlighted in this review reflect available guidelines, and represent cautious ('safe') haemostatic practice, they are likely to result in unnecessary transfusion for a significant number of NICU patients. Improved practice requires definition of a safe lower limit for platelet count in stable neonates; effective
platelet transfusion strategies for sick neonates; and improved
therapies for conditions precipitating severe
thrombocytopenia.