Multicenter Study

. 2024 Sep;68(8):1018-1030.

doi: 10.1111/aas.14467. Epub 2024 Jun 5.

Platelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study

Carl Thomas Anthon¹, Frédéric Pène², Anders Perner^{1

3

4}, Elie Azoulay⁴, Kathryn Puxty⁵, Andry Van De Louw⁶, Sanjay Chawla^{7

8}, Pedro Castro⁹, Pedro Povoa^{10

11

12}, Luis Coelho^{10

11}, Victoria Metaxa¹³, Matthias Kochanek¹⁴, Tobias Liebregts¹⁵, Thomas Kander^{16

17}, Mirka Sivula^{18

19}, Jo Bønding Andreasen²⁰, Lene Bjerregaard Nielsen²¹, Christine Lodberg Hvas²², Etienne Dufranc²³, Emmanuel Canet²⁴, Christopher John Wright²⁵, Julien Schmidt²⁶, Fabrice Uhel^{27

28}, Louai Missri²⁹, Mette Krag^{3

30}, Elisabet Cos Badia³¹, Cándido Díaz-Lagares^{32

33}, Sophie Menat³⁴, Guillaume Voiriot³⁵, Niels Erikstrup Clausen³⁶, Kristian Lorentzen³⁷, Reidar Kvåle^{38

39}, Andreas Barratt-Due⁴⁰, Thomas Hildebrandt⁴¹, Aleksander Rygh Holten^{42

43}, Kristian Strand⁴⁴, Morten Heiberg Bestle^{3

45}, Pål Klepstad^{46

47}, Damien Vimpere⁴⁸, Carolina Paulino⁴⁹, Catherina Lueck⁵⁰, Christian Svendsen Juhl⁵¹, Carolina Costa⁵², Per Martin Bådstøløkken⁵³, Lia Susana Aires Lêdo⁵⁴, Morten Hylander Møller^{1

3}, Lene Russell^{1

3

4}

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
² Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France.
⁵ Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
⁶ Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, Pennsylvania, USA.
⁷ Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁸ Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
⁹ Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS, University of Barcelona, Barcelona, Spain.
¹⁰ Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
¹¹ Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.
¹² Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
¹³ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
¹⁴ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁵ Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹⁶ Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
¹⁷ Department of Clinical Sciences, Lund University, Lund, Sweden.
¹⁸ Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁹ Coagulation Disorders Unit, Department of Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
²⁰ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
²¹ Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
²² Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
²³ Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Paris, France.
²⁴ Médecine Intensive Réanimation, CHU de Nantes, Université de Nantes, Nantes, France.
²⁵ Critical Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
²⁶ Service de réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Paris, France.
²⁷ Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Paris, France.
²⁸ Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Paris, France.
²⁹ Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
³⁰ Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark.
³¹ Department of Intensive Care, Hospital General Granollers, Barcelona, Spain.
³² Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
³³ SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
³⁴ Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
³⁵ Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Paris, France.
³⁶ Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
³⁷ Department of Intensive Care, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
³⁸ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
³⁹ Faculty of Medicine, University of Bergen, Bergen, Norway.
⁴⁰ Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
⁴¹ Department of Intensive Care, Zealand University Hospital - Roskilde, Roskilde, Denmark.
⁴² Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
⁴³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴⁴ Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway.
⁴⁵ Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
⁴⁶ Department of Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
⁴⁷ Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway.
⁴⁸ Médecine Intensive & Réanimation, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France.
⁴⁹ Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal.
⁵⁰ Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
⁵¹ Department of Anaesthesiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.
⁵² Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal.
⁵³ Department of Intensive Care B203, Akershus University Hospital, Lorenskog, Norway.
⁵⁴ Department of Intensive Care Medicine - Unit 2, Hospital Egas Moniz - CHLO, EPE, Lisbon, Portugal.

PMID: 38840310
PMCID: PMC11729610
DOI: 10.1111/aas.14467

Multicenter Study

Platelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study

Carl Thomas Anthon et al. Acta Anaesthesiol Scand. 2024 Sep.

. 2024 Sep;68(8):1018-1030.

doi: 10.1111/aas.14467. Epub 2024 Jun 5.

Authors

Affiliations

¹ Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
² Médecine Intensive & Réanimation, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Médecine Intensive & Réanimation, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France.
⁵ Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
⁶ Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, Pennsylvania, USA.
⁷ Critical Care Medicine Service, Department of Anesthesiology & Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁸ Department of Anesthesiology, Weill Cornell Medical College, New York, New York, USA.
⁹ Medical Intensive Care Unit, Hospital Clinic of Barcelona; IDIBAPS, University of Barcelona, Barcelona, Spain.
¹⁰ Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.
¹¹ Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal.
¹² Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark.
¹³ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
¹⁴ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁵ Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
¹⁶ Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
¹⁷ Department of Clinical Sciences, Lund University, Lund, Sweden.
¹⁸ Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
¹⁹ Coagulation Disorders Unit, Department of Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
²⁰ Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark.
²¹ Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark.
²² Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.
²³ Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique - Hôpitaux de Paris, Paris, France.
²⁴ Médecine Intensive Réanimation, CHU de Nantes, Université de Nantes, Nantes, France.
²⁵ Critical Care Unit, Queen Elizabeth University Hospital, Glasgow, UK.
²⁶ Service de réanimation médico-chirurgicale, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Paris, France.
²⁷ Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Paris, France.
²⁸ Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Paris, France.
²⁹ Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
³⁰ Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark.
³¹ Department of Intensive Care, Hospital General Granollers, Barcelona, Spain.
³² Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain.
³³ SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
³⁴ Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
³⁵ Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Paris, France.
³⁶ Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
³⁷ Department of Intensive Care, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
³⁸ Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
³⁹ Faculty of Medicine, University of Bergen, Bergen, Norway.
⁴⁰ Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
⁴¹ Department of Intensive Care, Zealand University Hospital - Roskilde, Roskilde, Denmark.
⁴² Department of Acute Medicine, Oslo University Hospital, Oslo, Norway.
⁴³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴⁴ Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway.
⁴⁵ Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
⁴⁶ Department of Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway.
⁴⁷ Department of Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway.
⁴⁸ Médecine Intensive & Réanimation, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Université Paris Cité, Paris, France.
⁴⁹ Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal.
⁵⁰ Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
⁵¹ Department of Anaesthesiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.
⁵² Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal.
⁵³ Department of Intensive Care B203, Akershus University Hospital, Lorenskog, Norway.
⁵⁴ Department of Intensive Care Medicine - Unit 2, Hospital Egas Moniz - CHLO, EPE, Lisbon, Portugal.

PMID: 38840310
PMCID: PMC11729610
DOI: 10.1111/aas.14467

Abstract

Background: Platelet transfusions are frequently used in the intensive care unit (ICU), but current practices including used product types, volumes, doses and effects are unknown.

Study design and methods: Sub-study of the inception cohort study 'Thrombocytopenia and Platelet Transfusions in the ICU (PLOT-ICU)', including acutely admitted, adult ICU patients with thrombocytopenia (platelet count <150 × 10⁹/L). The primary outcome was the number of patients receiving platelet transfusion in ICU by product type. Secondary outcomes included platelet transfusion details, platelet increments, bleeding, other transfusions and mortality.

Results: Amongst 504 patients with thrombocytopenia from 43 hospitals in 10 countries in Europe and the United States, 20.8% received 565 platelet transfusions; 61.0% received pooled products, 21.9% received apheresis products and 17.1% received both with a median of 2 (interquartile range 1-4) days from admission to first transfusion. The median volume per transfusion was 253 mL (180-308 mL) and pooled products accounted for 59.1% of transfusions, however, this varied across countries. Most centres (73.8%) used fixed dosing (medians ranging from 2.0 to 3.5 × 10¹¹ platelets/transfusion) whilst some (mainly in France) used weight-based dosing (ranging from 0.5 to 0.7 × 10¹¹ platelets per 10 kg body weight). The median platelet count increment for a single prophylactic platelet transfusion was 2 (-1 to 8) × 10⁹/L. Outcomes of patients with thrombocytopenia who did and did not receive platelet transfusions varied.

Conclusions: Among acutely admitted, adult ICU patients with thrombocytopenia, 20.8% received platelet transfusions in ICU of whom most received pooled products, but considerable variation was observed in product type, volumes and doses across countries. Prophylactic platelet transfusions were associated with limited increases in platelet counts.

Keywords: critical illness; intensive care unit; platelet transfusion; thrombocytopenia.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

The Department of Intensive Care at Rigshospitalet (CTA, AP, MHM, LR) has received funding for other research projects from Sygeforsikringen ‘danmark’, and the Novo Nordisk Foundation. FP has received honoraria for consulting and lectures from Gilead and an institutional grant from Alexion Pharma. AP has received honorarium from Novartis for participation in an advisory board. EA has received research grants from MSD Avenir and Alexion and honoraria for lectures from Alexion, Sanofi and Pfizer. AVDL has received honoraria from Sanofi for participation in an advisory board. PC has received consulting fees from Sanofi, Gilead, Alexion and Janssen and honoraria for lectures from Merck Sharp & Dohme, Gilead, Alexion and Pfizer. PP has received consulting fees from Sanofi and Gilead and honoraria from Merck Sharp & Dohme, Gilead, Mundipharma and Pfizer for academic and educational work. EC received fees for lectures and conference talks and had travel and accommodation expenses related to attending scientific meetings covered by Gilead, Shionogi B.V. and SanofiGenzyme. ARH has received honoraria from Pfizer for lectures. MHB has received consulting fees from AM-pharma and Inotrem. CL has received consulting fees from Gilead. MS has received honoraria for lectures and consulting from CSL Behring, Alexion AstraZeneca Rare Disease and Takeda. KS has received consulting fees from Paion. None of these had any relation to the current work.

Figures

**FIGURE 1**
Platelet count increments for prophylactic transfusions. Distribution of platelet increments for 161 prophylactic transfusions used as single transfusions in ICU. Below the histogram is a horizontal box plot: the dot represents the median, the thick line represents the interquartile range and the thin line represents the range. The dashed red line marks a platelet increment of 0. Platelet increments could not be calculated for 22/183 (12.0%) prophylactic platelet transfusions (details in Data S1). ICU, intensive care unit.

**FIGURE 2**
Number of patients receiving platelet transfusions in ICU according to days since ICU admission. Data are presented for all platelet transfusions and stratified by indication. Day 1 represents the day of ICU admission. The black part of each bar represents patients who received their first platelet transfusions on this day, and the orange part represents patients who received a platelet transfusion on this day but previously had received another. An identical figure is presented in eFigure 8 in Data S1 including transfusions used in operating rooms. ICU, intensive care unit.

**FIGURE 3**
Timing and number of platelet transfusions in ICU. Timing and number of platelet transfusions used amongst the 105 patients who received platelet transfusion in ICU. Each horizontal line of tiles represents a patient, the grey-coloured tiles represent days in ICU where no platelets were transfused and the orange-coloured tiles represent days in ICU where the patient was transfused with platelets. The colour intensity corresponds to the number of platelet transfusions received that day. The median number of days with platelet transfusion was 2 (IQR 1–4) per patient and number of transfusions administered on these days was 1 (1–2). Similar figures for each indication and including transfusions used in operating rooms are presented in eFigures 9–12 in Data S1. ICU, intensive care unit.

See this image and copyright information in PMC

Cited by

Platelet transfusion practice in the intensive care unit: the Nine-I international platelet transfusion survey.
Russell L, Azoulay E, Anthon CT, Pène F, Akella P, Mabrouki A, Puxty K, Nielsen LB, Andreasen JB, Kander T, Sjövall F, Hästbacka J, Hvas CL, Van De Louw A, Chawla S, Bauer PR, Castro P, Povoa P, Coelho L, Fernandez S, Topeli A, Barratt-Due A, Barbaglio C, Kochanek M, Martin-Loeches I, Kentish-Barnes N. Russell L, et al. Ann Intensive Care. 2025 Jul 8;15(1):91. doi: 10.1186/s13613-025-01494-4. Ann Intensive Care. 2025. PMID: 40627074 Free PMC article.

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Platelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study

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Platelet transfusions in adult ICU patients with thrombocytopenia: A sub-study of the PLOT-ICU inception cohort study

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Conflict of interest statement

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