Landmark Series
PlaNeT-2: when to give platelets
A higher platelet transfusion threshold seemed safer. In preterm infants, the trial found the opposite.
Source: Curley A, et al. N Engl J Med. 2019;380(3):242–251.
The question
In preterm infants with severe thrombocytopenia, at what platelet count should a prophylactic platelet transfusion be given?
The study
- Multicenter randomized trial in infants born before 34 weeks who developed severe thrombocytopenia.
- Transfusion at a high threshold (50,000/mm³) versus a low threshold (25,000/mm³).
- 660 infants: median birth weight 740 g, median gestational age 26.6 weeks.
- Primary outcome: death or new major bleeding within 28 days of randomization, assessed with a validated bleeding tool.
What they found
26% vs 19%Death or major bleeding, high vs low threshold
OR 1.5795% CI 1.06–2.32
50% vs 39%Death or NDI at 2 years
- 90% of the high-threshold group received at least one platelet transfusion, compared with 53% of the low-threshold group.
- Death or new major bleeding: 26% vs 19% (odds ratio 1.57; 95% CI 1.06–2.32).
- Serious adverse events did not differ significantly (25% vs 22%).
- Two-year follow-up (601 of 653 eligible children): death or significant neurodevelopmental impairment in 50% of the high-threshold group vs 39% of the low-threshold group (OR 1.54; 95% CI 1.09–2.17).
Where the evidence stops
- The trial compared two thresholds. It does not tell us whether thresholds below 25,000/mm³ are safe.
- It studied prophylactic transfusion in preterm infants. It is not a guide to treating active bleeding or to term infants.
- The trial does not explain why more transfusion was linked to more harm. That is a question for further research.
References
- Curley A, Stanworth SJ, Willoughby K, et al. Randomized Trial of Platelet-Transfusion Thresholds in Neonates. N Engl J Med. 2019;380(3):242–251. doi:10.1056/NEJMoa1807320 · PubMed 30387697
- Moore CM, D'Amore A, Fustolo-Gunnink S, et al. Two-year outcomes following a randomised platelet transfusion trial in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2023;108(5):452–457. doi:10.1136/archdischild-2022-324915 · PubMed 36810309
Independent educational content, not medical advice. Not affiliated with or endorsed by the AAP. Summaries reflect the published papers; read the originals before changing practice.
