143 - Changes in Inflammatory Cytokines after Platelet Transfusion in a Neonatal Population

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 143
Publication Number: 143.239

Carmel Maria Moore, National Maternity Hospital, Dublin, Dublin, Ireland; Anna Curley, National Maternity Hospital, Dublin, Dublin, Ireland

Presenting Author(s)

Carmel Maria Moore, MB BCh (she/her/hers)

Neonatologist and Research Fellow
National Maternity Hospital
Dublin, Dublin, Ireland

Background: Studies – including the large, multicentre randomized controlled PlaNeT-2/MATISSE trial - have demonstrated increased morbidity and mortality with platelet transfusions in the neonatal period. Platelets are as important for host immunity, inflammation and angiogenesis as they are for hemostasis. Increased inflammation may explain the dose-associated increase in mortality, bleeding and lung disease demonstrated in prospective and retrospective evidence.

Objective: This study aims to assess if the there are any changes in inflammatory cytokines post-platelet transfusion in babies in NICU

Design/Methods: This multicentre prospective observational study recruited babies who were due to receive a non-emergency platelet transfusion. Two bloodspot samples were collected prior to transfusion, from indwelling access, scheduled venous access or capillary sampling, and two samples were collected two hours after transfusion. Samples were processed using high-throughput, multiplex immunoassay by Olink (Uppsala, Sweden) in order to enable analysis with of tiny blood volumes. Statistical analysis was performed using SPSS. Normally distributed data was tested with paired sample t-tests, Non-parametric tests (related samples Wilcoxon signed rank test) were used when data was not normally distributed.

Results:

17 babies underwent 26 platelet transfusions across the two centres. Pre-transfusion and post-transfusion samples were collected from all babies for all included transfusions. Median birthweight was 1545g (535-3960g) and median gestation at birth was 31 weeks and one day (23+1 – 40+5). Median pre-transfusion platelet count was 19.5x10⁹/l (5-85) and median transfusion duration was 60 minutes (30-60). Median platelet increment where available was 36.5x10⁹/l (-13-101).

There was a significant increase in levels of CXCL5 (p< 0.001), CD40 (p< 0.001), TGF β (p< 0.001) in neonatal blood samples post-platelet transfusion in the study group.

Conclusion(s): There was an increase in CXCL5, CD40 and TGF β after platelet transfusion in babies in NICU. < ![if !supportAnnotations] >[CM1]< ![endif] > These are key thromboinflammatory modulators released by platelets. CXCL5 has been associated with NEC, BPD and white matter injury. TGF β has been associated with BPD and post-haemorrhagic hydrocephalus. CD40 has been associated with ROP. This could potentially explain long term harm from platelet transfusion in babies.