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. 2025 Jul;65(7):1231-1241.
doi: 10.1111/trf.18290. Epub 2025 May 27.

How experienced ICU specialists make decisions on prophylactic platelet transfusions-A qualitative study

Lene Russell  1   2   3 , Kathryn Puxty  4 , Elie Azoulay  3   5 , Joanne McPeake  6 , Nancy Kentish-Barnes  3   5
Affiliations

How experienced ICU specialists make decisions on prophylactic platelet transfusions-A qualitative study

Lene Russell et al. Transfusion. 2025 Jul.

Abstract

Background: Platelet transfusions are frequently used in the Intensive Care Unit (ICU) as prophylaxis against bleeding complications. Several guidelines exist on when to administer platelet transfusions in the ICU, but studies indicate that these guidelines are not necessarily followed. The aim of this qualitative study was to understand how experienced ICU physicians make decisions on prescribing prophylactic platelet transfusions and to gain insight into their general concerns and views on blood product transfusions.

Design: Descriptive qualitative study using semi-structured, in-depth interviews with clinicians working in ICUs in Austria, Denmark, France, Germany, Spain, and the United Kingdom. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

Results: We identified four main themes influencing the decision to prescribe prophylactic platelet transfusions: Guidelines, social and cultural aspects (including religion), previous personal experiences, and fear of consequences.

Discussion: Most doctors expressed uncertainty about balancing benefits and harm. Platelet transfusions were often used to prevent bleeding despite uncertainty on the effect and were typically triggered by fear of consequences when performing a procedure, which was an important driver. The departmental culture and colleagues' attitudes were far more important influencers on decision-making than guideline recommendations. Most doctors thought it was possible for blood products to transfer unknown and potentially harmful substances to patients, although this did not appear to influence their daily practice.

Keywords: bleeding; decision‐making; department culture; guidelines; platelet transfusions; thrombocytopenia.

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Conflict of interest statement

Dr. Russell received funding from the Dagmar Marshalls Foundation. Dr. Kentish‐Barnes' institution received funding from the French Ministry of Health. Professor Azoulay's institution received funding from Fisher & Paykel, MSD, Pfizer, Baxter, and Gilead, and he received funding from Gilead, Baxter, Alexion, Ablynx, and Pfizer. Professor McPeake's institution received funding from Astrazeneca. Dr. Kathryn Puxty has no conflict of interest.

Figures

FIGURE 1
FIGURE 1
The four themes influencing the decision to transfuse platelets to critically ill patients. During the interviews, we identified four main themes influencing the decision of whether to administer a prophylactic platelet transfusion. Within each theme, recurring aspects were found during the interviews.
FIGURE 2
FIGURE 2
The main themes influencing decision‐making are illustrated here with relevant quotes.
See this image and copyright information in PMC

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References

    1. Sagy I, Jotkowitz A, Barski L. Reflections on cultural preferences and internal medicine: the case of Jehovah's witnesses and the changing thresholds for blood transfusions. J Relig Health. 2017;56:732–738. - PubMed
    1. Garraud O, Lefrère JJ. Blood and blood‐associated symbols beyond medicine and transfusion: far more complex than first appears. Blood Transfus. 2014;12:14–21. - PMC - PubMed
    1. Arnold DM, Crowther MA, Cook RJ, Sigouin C, Heddle NM, Molnar L, et al. Utilization of platelet transfusions in the intensive care unit: indications, transfusion triggers, and platelet count responses. Transfusion. 2006;46:1286–1291. - PubMed
    1. Stanworth SJ, Walsh TS, Prescott RJ, Lee RJ, Watson DM, Wyncoll DLA. Thrombocytopenia and platelet transfusion in UK critical care: a multicenter observational study. Transfusion. 2013;53:1050–1058. - PubMed
    1. Schiffer CA, Bohlke K, Delaney M, Hume H, Magdalinski AJ, McCullough JJ, et al. Platelet transfusion for patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2018;36:283–299. - PubMed

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