Improvising neonatal thrombocytopenia management: Insights from split, volume-reduced, single-donor apheresis platelets (NeoVRs-SDAP)

Abstract

Introduction: Thrombocytopenia is common in neonates, managed with platelet transfusions at defined dose. The product type varies from neonatal-specific units using platelet additive solutions to adult products split into multiple paediatric units. In low-middle-income countries, whole blood-derived random donor platelets (RDP) are common while western countries use split adult single donor apheresis platelets (SDAP). We aimed to assess preliminary effectiveness of split, volume-reduced single donor apheresis platelets (NeoVRs-SDAP) in neonatal thrombocytopenia and observe early post-transfusion outcomes. Methods: Study was conducted from August 2024 to January 2025 at a tertiary healthcare centre. Persistent thrombocytopenic neonates admitted to the NICU were transfused with NeoVRs-SDAP prepared using Spectra Optia® with modified pro gram yielding an adult dose (300 109) in a reduced 100 mL of product volume. These were split into 2–5 aliquots for transfusion. Post-transfusion platelet incre ments and percentage recovery were assessed after 20–24 h. Results: Thirteen neonates' 77% preterm, 69.2% VLBW with sepsis received 46 NeoVRs-SDAP. 10 mL of this product contained nearly 3 times more platelets than RDP and 1.5 times more than adult SDAP of same volume. The mean transfused dose was 70.56 ± 14.21 109 platelets. Median platelet increment was 64 500/μL versus 15 477/μL for RDP (p < 0.001). Platelet recovery ranged from 7.5%–52.5%. Split products reduced donor exposure by 56.5%. Survival was 62%, without any transfusion-related adverse events. Conclusion: NeoVRs-SDAP may be potential alternative in persistent neonatal thrombocytopenia, offering better increments and recovery, reduced donor expo sure, and leukoreduction. Further RCTs comparing NeoVRs-SDAP and RDP are recommended.