ORIGINAL RESEARCH Platelet transfusion practices in immune thrombocytopenia related hospitalizations Ruchika Goel, MD, MPH , 1,2 Saurav Chopra, MD, 3 Aaron A. R Tobian, MD, PhD, 1 Paul M. Ness, MD, 1 Steven M. Frank, MD, 4 Melissa Cushing, MD , 5 Ljiljana Vasovic, MD , 5 Shipra Kaicker, MD, 5 Clifford Takemoto, MD, 5 Cassandra D. Josephson, MD, 6,7 Marianne Nellis, 5 James Bussel, MD, 5 and Lakshmanan Krishnamurti, MD 7 BACKGROUND: The role of platelet transfusions in management of Immune Thrombocytopenia (ITP) remains controversial. Current guidelines recommend that platelet transfusions in ITP be reserved for catastrophic hemorrhage or invasive surgical procedures. This study assesses the nationwide platelet transfusion practices in hospitalized children and adults with ITP. STUDY DESIGN AND METHODS: We studied hospitalizations with ITP as the primary admitting diagnosis from 2010–2014 in National Inpatient Sample (NIS), the largest all-payer inpatient database. Univariate and multivariable logistic regression analyses were used to determine factors predicting platelet transfusions. Sampling weights were applied to generate nationally representative estimates. Propensity score matching was used to perform sensitivity analyses. RESULTS: From 2010 to 2014, there were 78,376 admissions with ITP as the primary admission diagnosis (mean Æ SD age: 45 Æ 27 years; females 56%, children [age < 18 years] 22%) and 282,285 with ITP as one of all the admission diagnoses. Overall, 27% admissions were with ITP as primary (children 4%) and 15% admissions with ITP as one of all the diagnoses documented with at least one platelet transfusion. On multivariable adjustment the following factors were associated with worsening disease severity and a higher odds of platelet transfusion, adult age (adjOR = 9.03, 95% CI = 7.40–11.02), male gender (adjOR = 1.21, 95% CI = 1.11–1.31), bleeding occurrence (intracranial/gastrointestinal/ genitourinary/epistaxis) (adjOR = 1.78, 95% CI = 1.61–1.96), admission to rural non-teaching hospital (adjOR = 1.85, 95% CI = 1.52–2.22), and small bed-size hospital (adjOR = 1.23, 95% CI = 1.05–1.45).. Of admissions reporting platelet transfusions, only 26% reported a bleeding complication, and 11% had a major operating-room surgery/procedure. Overall, 65% of transfused patients had neither bleeding nor a major operative procedure during the hospitalization. Admissions with platelet transfusions had a significantly longer mean length of hospitalization 2.2 days (95% CI = 1.96–2.41, p < 0.001), and accrued higher mean total hospital charges; $31,150 USD (95% CI = 27,644–34,656, p < 0.001). However, platelet transfusions were not associated with in-hospital mortality (adjOR = 1.02, 95% CI = 0.73–1.45, p = 0.892). CONCLUSION: Platelets are administered to a small fraction of the hospitalized ITP patients. In a majority of these cases however, platelet usage does not appear to be concordant with the current guidelines or associated with improvement in clinical outcomes. I mmune thrombocytopenia (ITP) is an autoimmune disorder characterized by increased platelet destruc- tion, resulting in low platelet counts. 1 The annual inci- dence is estimated to be 5 cases per 100,000 population. 2 Patients with ITP have variable bleeding symp- toms; the majority have only mild muco-cutaneous bleed- ing, but in some there may be severe, life-threatening internal organ bleeding. 2–4 Therapeutic options in ITP patients to increase the platelet count should balance the risks of significant bleeding with thrombocytopenia versus the potential adverse effects of the treatment such as corti- costeroids or intravenous gamma globulin (IVIG). 3,5,6 The role of platelet transfusions in the management of ITP remains controversial. The clinical benefit of a platelet From the 1 Department of Pathology, Johns Hopkins University, Baltimore, Maryland; 2 Division of Hematology Oncology, Simmons Cancer Institute at SIU School of Medicine, Springfield, Illinois; 3 Department of Pathology, University of Iowa School of Medicine, Iowa City, Iowa; 4 Department of Anesthesiology/Critical Care Medicine and the Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland; 5 Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland; 6 Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia; and the 7 Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Department of Pediatrics, Division of Hematology/ Oncology, Emory University School of Medicine, Atlanta, Georgia. Address reprint requests to: Ruchika Goel, MD, MPH, Depart- ment of Pathology, Johns Hopkins University, Baltimore, Maryland, MD, and Simmons Cancer Institute at SIU School of Medicine, Springfield, IL; e-mail: rgoel6@jhmi.edu Received for publication November 21, 2017; revision received August 28, 2018; and accepted August 29, 2018. doi:10.1111/trf.15069 © 2018 AABB TRANSFUSION 2018;9999;1–8 TRANSFUSION 1