Evaluation of platelet concentrate prescription in pediatric patients at a tertiary care hospital

ABSTRACT Objective: To verify the adequacy of platelet concentrate prescription by pediatricians in different pediatric sectors of a general hospital. Methods: A cross-sectional study evaluating 218/227 platelet concentrate records in children and adolescents (zero to 13 years old), from January 2007 to April 2015, by the pediatricians of the emergency room, sick bay and intensive care unit. The requisitions were excluded in patients with hematological diseases and those without the number of platelets. Results: Children under 12 months received 98 platelet concentrates (45.2%). Most of the transfusions were prophylactic (165; 79%). Regarding the transfusion site, 39 (18%) were in the emergency room, 27 (12.4%) in the sick bay and 151 (69.6%) in the intensive care unit. The trigger, prescribed volume and platelet concentrate subtype were adequate in 59 (28.2%), 116 (53.5%) and 209 (96.3%) of the transfusions, respectively. Patients with hemorrhage presented adequacy in 42 (95.5%), while children without bleeding presented in 17 (10.3%). The most common inadequacy related to volume was the prescription above recommendation (95; 43.8%). Eight platelet concentrates were prescribed with subtype requests without indication. Conclusion: The results obtained in this study showed that transfusion of platelet concentrate occurred more adequately in children with active bleeding compared to prophylactic transfusion. There was a tendency to prescribe high volumes and platelet subtypes not justified according to current protocols. The teaching of transfusion medicine should be more valued at undergraduate and medical residency.

摘要 目的：验证某综合医院不同儿科科室的儿科医师开具的血小板浓缩液（platelet concentrate）处方合理性。方法：本研究为横断面研究，纳入2007年1月至2015年4月期间，来自急诊科、普通病房及重症监护室的儿科医师开具的227份儿童及青少年（0至13岁）血小板浓缩液输注记录，剔除血液系统疾病患者及未记录血小板计数的输血申请单后，最终分析218份有效数据。结果：12月龄以下儿童共接受98份血小板浓缩液输注，占总输注量的45.2%。绝大多数输注为预防性输注（165份，占79.0%）。按输注场所划分，急诊科39份（18.0%）、普通病房27份（12.4%）、重症监护病房151份（69.6%）。输注触发指征、处方剂量及血小板浓缩液亚型的合规率分别为28.2%（59份）、53.5%（116份）及96.3%（209份）。合并出血症状的患者中，42份（95.5%）处方合规；无出血症状的儿童中，仅17份（10.3%）处方合规。与剂量相关的最常见不合规情况为处方剂量超出推荐标准（95份，占43.8%）。另有8份血小板浓缩液的亚型申请无对应临床指征。结论：本研究结果显示，相较于预防性输注，合并活动性出血的患儿其血小板浓缩液输注处方合规性更高。临床存在处方剂量偏高、无指征开具血小板浓缩液亚型的趋势。输血医学的教学在本科医学教育及住院医师规范化培训中应得到更多重视。