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Observational Study
. 2025 Jan;65(1):73-87.
doi: 10.1111/trf.18071. Epub 2024 Dec 18.

Plasma transfusion in the intensive care unit

Maite M T van Haeren  1   2 , Senta Jorinde Raasveld  1   2 , Sanne de Bruin  1 , Merijn C Reuland  1 , Claudia van den Oord  1 , Jimmy Schenk  1   2   3 , Cécile Aubron  4 , Jan Bakker  5   6 , Maurizio Cecconi  7 , Aarne Feldheiser  8 , Harm-Jan de Grooth  1 , Jens Meier  9 , Thomas W L Scheeren  10 , Zoe McQuilten  11 , Andrew Flint  11   12 , Tarikul Hamid  13 , Michaël Piagnerelli  14 , Tina Tomić Mahečić  15 , Jan Benes  16 , Lene Russell  17   18   19 , Hernan Aguirre-Bermeo  20 , Konstantina Triantafyllopoulou  21 , Vasiliki Chantziara  22 , Mohan Gurjar  23 , Sheila Nainan Myatra  24 , Vincenzo Pota  25 , Muhammed Elhadi  26 , Ryszard Gawda  27 , Mafalda Mourisco  28 , Marcus Lance  29 , Vojislava Neskovic  30 , Matej Podbregar  31 , Juan V Llau  32 , Manual Quintana-Diaz  33 , Maria Cronhjort  34 , Carmen A Pfortmueller  35 , Nihan Yapici  36 , Nathan D Nielsen  37 , Akshay Shah  38 , Alexander P J Vlaar  1 , Marcella C A Müller  1 ; InPUT Study Group
Collaborators, Affiliations
Observational Study

Plasma transfusion in the intensive care unit

Maite M T van Haeren et al. Transfusion. 2025 Jan.

Abstract

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study design and methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5.

Discussion: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

Keywords: ICU; critically ill; intensive care unit; plasma; transfusion; transfusion practices.

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Conflict of interest statement

Dr. Cecconi reported receiving personal fees from Edwards Lifesciences, GE Healthcare, and Directed Systems outside the submitted work. Dr. Shah reported receiving consultancy fees from Pharmacosmos UK outside of the submitted work. Dr. Feldheiser reported receiving personal fees from Baxter and Medtronic outside the submitted work. Dr. Scheeren reported serving as senior medical director for Edwards Lifesciences (Garching, Germany). Dr. McQuilten reported receiving grants from Australian National Blood Authority and National Health and Medical Research Council during the conduct of the study. Dr. Flint reported receiving grants from the Australian National Blood Authority and Blood Synergy (Monash University) during the conduct of the study. Dr. Piagnerelli reported receiving grants from Centre Federal d'Expertise Belge–KCE grant for COVID‐19 study outside the submitted work. Dr. Gurjar reported receiving royalties for edited books (Manual of ICU Procedures and Textbook of Ventilation, Fluids, Electrolytes and Blood Gases) from the publisher Jaypee Brothers Medical Publishers (Pvt) Ltd., New Delhi. Dr. Pfortmueller reported receiving grants from Orion Pharma, Abbott Nutrition International, B Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd., Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica SA, Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, GlaxoSmithKline, Merck Sharp and Dohme AG, Eli Lilly and Co, Baxter, Boehringer Ingelheim, Aseptuva, Astellas, AstraZeneca, CSL Behring, Novartis, Covidien, and Nycomed outside the submitted work; the funds were paid into departmental funds and no personal financial gain applied. Dr. Nielsen reported receiving personal fees from Adrenomed outside the submitted work. Dr. Vlaar reported receiving personal fees from a Vidi grant (ZonMW: 09150172010047). No other disclosures were reported.

Figures

FIGURE 1
FIGURE 1
Flowchart of included countries and centers.
FIGURE 2
FIGURE 2
Flowchart and alluvial plot of included patients and transfusion events. On the left: a flowchart of included patients, transfusion events and plasma units; on the right: alluvial plot with on the left the transfusion indication of the event and on the right the pre‐transfusion event INR. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Plasma transfusion practices per continent. Panel A: Occurrence rate of plasma transfusion in the ICU per continent and in total, including as part of massive transfusion protocol (MTP). Panel B: Proportion of plasma transfusion events of the total transfusion events of all products (Red Blood Cells, Platelets and Plasma) per continent and in total, including MTP. Panel C: Distribution of proportions of transfusion indications per continent and in total, excluding MTP. Panel D: Proportions of unknown INR, INR > 3.0, INR 1.5–3.0, and INR < 1.5 of the transfusion events for a non‐bleeding indication (defined as prophylatic or pre‐procedure) per continent and in total, excluding MTP. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Histograms of plasma units by transfusion indication and pre‐transfusion INR. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 5
FIGURE 5
INR change per pre‐transfusion INR and per transfusion indication. [Color figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

References

    1. Stanworth SJ, Walsh TS, Prescott RJ, Lee RJ, Watson DM, Wyncoll D, et al. A national study of plasma use in critical care: clinical indications, dose and effect on prothrombin time. Crit Care. 2011;15:R108. - PMC - PubMed
    1. Warner MA, Chandran A, Jenkins G, Kor DJ. Prophylactic plasma transfusion is not associated with decreased red blood cell requirements in critically ill patients. Anesth Analg. 2017;124:1636–1643. - PMC - PubMed
    1. Stanworth SJ, Grant‐Casey J, Lowe D, Laffan M, New H, Murphy MF, et al. The use of fresh‐frozen plasma in England: high levels of inappropriate use in adults and children. Transfusion. 2011;51:62–70. - PubMed
    1. Vlaar AP, Oczkowski S, de Bruin S, Wijnberge M, Antonelli M, Aubron C, et al. Transfusion strategies in non‐bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2020;46:673–696. - PMC - PubMed
    1. Vlaar APJ, Dionne JC, de Bruin S, Wijnberge M, Raasveld SJ, van Baarle F, et al. Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2021;47:1368–1392. - PMC - PubMed

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