Editor: Deborah Sesok-Pizzini, MD, MBA, adjunct professor, Department of Clinical Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and vice chair for clinical pathology and transfusion medicine, Nemours Children’s Health, Wilmington, Del.
Opportunities to improve platelet transfusion practice: a retrospective audit
October 2026—Evidence-based guidelines for platelet use help prevent unnecessary transfusion and inform better transfusion practice. Platelet transfusions can be used to prophylactically prevent bleeding or treat bleeding. Many studies have found that liberal use of platelets can cause harm, instead of benefits, in various settings. Due to the frequent involvement of platelets in transfusion reactions and their shelf-life of five to seven days, optimizing platelet use can benefit patient safety and supply management. A recent large audit found that platelets were most commonly unnecessarily used for prophylactic platelet transfusion with a pretransfusion platelet count above 10 × 109/L, which is arguably the area of platelet transfusion with the most significant evidence to support the use of practice guidelines. The authors conducted a study in which they evaluated platelet transfusions in a large multicenter research database to gain a deeper understanding of patient populations being transfused platelets, laboratory thresholds triggering transfusion, and variability in practices and hospital or physician factors that impact platelet guideline compliance. The authors’ retrospective analysis focused on platelet guideline compliance among adults admitted to the services of general medicine, subspecialty medicine, or critical care from Jan. 1, 2017 to June 30, 2022. The study involved 821,950 patient admissions at 22 hospitals and identified 56,825 platelet transfusion events. Guideline adherence was defined as platelet transfusion below 100 × 109/L for neurosurgical, cardiac, or extracorporeal membrane oxygenation indications; platelet transfusion below 50 × 109/L for invasive procedures, bleeding, or therapeutic anticoagulation; and platelet transfusion below 10 × 109/L for patients who did not have an immune-mediated thrombocytopenia. The study found that 13,199 (23.2 percent) platelet transfusions did not comply with the guidelines. The highest rates of compliance failure were observed with antiplatelet therapy (48.5 percent), cardiac surgery (49.7 percent), invasive procedures (29.2 percent), immune-mediated thrombocytopenia (32.9 percent), and primary prophylaxis (47.2 percent). After adjusting for physician-specific characteristics, a lower overall risk of guideline noncompliance was noted for platelet transfusion at academic hospitals versus community hospitals (odds ratio, 0.768; 95 percent confidence interval, 0.678–0.871; p <.001). The authors deduced that this is most likely due to the increased likelihood of blood bank oversight by transfusion medicine specialists and a higher influx of medical trainees incorporating new evidence into the practice. Physician specialty, but not physician gender or years in practice, was shown to influence compliance as well. As part of their study, the authors also described a simple tool for defining platelet transfusion practice that can easily extract information from administrative EMR databases. The definitions of guideline compliance were developed from published literature. In areas of more historical controversy, the authors chose more liberal criteria, which may have overestimated compliance. Of note, although hematology/oncology physicians had the highest rates of guideline-compliant transfusions, they also had the largest number of noncompliant platelet transfusions, especially for prophylactic transfusions above 10 × 109/L. The authors concluded that substantial variability in platelet transfusion across specialties and hospital settings persists. Using an electronic tool that employs real-world EMR data linked with administrative data, they can apply guideline-based criteria to better assess transfusion guideline compliance.
Ryan S, Liu Y, Raza S, et al. Opportunities for improving platelet transfusion practice: A large retrospective audit across 22 hospitals. Br J Haematol. 2026;208:670–682.
Correspondence: Dr. Sarah Ryan at 11sgfr@queensu.ca
Demographic, birth, and parental characteristics linked to risk of early-onset colorectal cancer
The incidence of early-onset colorectal cancer (EOCRC) is on the rise and defined by a colorectal cancer diagnosis before age 50. EOCRC is now the leading cause of cancer-related mortality in this age group in the United States. In comparison to late-onset CRC, EOCRC often presents at an advanced stage due in part to its aggressive pathology. Colon cancer associated with EOCRC is typically found in the rectum and distal colon. Cancer in these locations is associated with a Western diet high in red and processed meat and alcohol consumption. Of note, a birth cohort effect linked to this type of diet has been observed in EOCRC and happens when a disease risk varies by birth year due to changes in exposure patterns. The authors conducted a large population-based nested case-control study to evaluate the association between a comprehensive set of demographic, birth, and parental characteristics and risk of EOCRC among people born in California. They took into account sex and age at diagnosis. Hispanic ethnicity was an important study factor as Hispanics represent the largest birth population affected by EOCRC and are the fastest growing minority group in the United States. The study included 1,221 subjects born in California between 1982 and 2021 and diagnosed with EOCRC by 39 years of age, who were matched to 61,050 controls based on birth year. The authors used the California Linkage Study of Early-Onset Cancer, which links California birth records maintained at the California Department of Public Health with statewide cancer diagnosis data from the California Cancer Registry. They analyzed the data using odds ratios (OR) and multivariable logistic regression models. The results showed that males had a 34 percent higher risk of EOCRC than females (OR, 1.34; 95 percent confidence interval [CI], 1.20–1.51) and that Hispanic ethnicity was associated with a 43 percent higher risk of EOCRC (OR for Hispanic versus non-Hispanic white, 1.34; 95 percent CI, 1.20–1.51). Of interest, having a foreign-born mother was associated with a lower risk of EOCRC (OR, 0.85; 95 percent CI, 0.73–0.97). The reason for this is unclear but may have to do with better dietary and behavioral practices, which lower the likelihood of obesity during pregnancy. Every 500-g increase in birth weight among females was associated with a 10 percent increase in EOCRC risk (OR, 1.10; 95 percent CI, 1.01–1.21). A higher risk of EOCRC was also observed in study participants born to fathers 35 years or older (OR, 1.56; 95 percent CI, 1.08–2.25). No other demographic, birth, or parental characteristics were significantly associated with risk of EOCRC. The authors noted that this may be the largest study evaluating the relationship between a comprehensive set of variables and risk of EOCRC and that it includes a large percentage of Hispanics, a group underrepresented in prior studies. They concluded that high birth weight, male sex, Hispanic ethnicity, and older paternal age were associated with EOCRC, and the protective effects of EOCRC may include maternal birthplace. The mechanisms that link these variables with risks of EOCRC require further research. This study, among others, may support the case for evaluating EOCRC screening practices, such as those related to age- and ethnicity-related risks, for parents and offspring.
Siddique S, Wang R, Berardi D, et al. Demographic, birth, parental characteristics, and the risk of early-onset colorectal cancer: A population-based nested case-control study in California. Cancer. 2026. doi.org/10.1002/cncr.70458
Correspondence: Dr. Sunny Siddique at sunny.siddique@yale.edu