Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep 26.
doi: 10.1097/CCM.0000000000006880. Online ahead of print.

Platelet Transfusion Practices in the ICU: A Prospective Multicenter Cohort Study

Stefan F van Wonderen  1 , Senta Jorinde Raasveld  1   2 , Andrew W J Flint  3   4 , Jimmy Schenk  1   2   5 , Claudia van den Oord  1 , Merijn C Reuland  1 , Sanne de Bruin  1 , Jan Bakker  6   7   8 , Maurizio Cecconi  9 , Aarne Feldheiser  10 , Jens Meier  11 , Marcella C A Müller  1 , Thomas W L Scheeren  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 , Harm-Jan de Grooth  1   39 , Zoe McQuilten  3 , Alexander P J Vlaar  1 , Cécile Aubron  40 ; InPUT Study Group
Collaborators, Affiliations

Platelet Transfusion Practices in the ICU: A Prospective Multicenter Cohort Study

Stefan F van Wonderen et al. Crit Care Med. .

Abstract

Objective: There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations.

Design: International prospective cohort study.

Setting: Two hundred thirty-three centers in 30 countries worldwide.

Patients: All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to October 2022), were included.

Interventions: None.

Measurements and main results: Of the 3643 patients, 208 (6%) received a platelet transfusion during their ICU stay and main indications consisted of active bleeding (42%, n = 187/443), prophylaxis (33%, n = 144/443) or an upcoming procedure (12%, n = 51/443). The median platelet count before transfusion was 44 × 109/L (interquartile range [IQR], 20-78) with variation by indication, including a higher median of 60 × 109/L (IQR 31-93) during active bleeding. A threshold for transfusion was stated in 51% (n = 224/443) of the events, with a median threshold platelet count of 50 × 109/L (IQR, 40-100). The advised threshold was not adhered to in 16% (n = 36/224) of cases, with the majority having active bleeding as indication. Contrasts in transfusion practices were observed across different geo-economic regions. Platelet transfusions were administered to 6% (n = 156/2520) of patients in high-income countries, 5% (n = 52/1069) of patients in upper-middle-income countries and in none from lower-middle-income countries (n = 0/54). Non-adherence was higher in the high-income countries (23%, n = 34/149) than upper-middle-income countries (3%, n = 2/75).

Conclusions: Platelet transfusions were administered to a small proportion of critically ill patients, and were given to treat active bleeding or as prophylaxis in the majority of cases. Occurence rate, indication and threshold adherence for platelet transfusion widely varied between geo-economic regions.

Keywords: intensive care unit; platelet; thresholds; thrombocytopenia; transfusion.

PubMed Disclaimer

Conflict of interest statement

This study was endorsed, but not financially supported, by the European Society of Intensive Care Medicine. Dr. Flint reported receiving grants from the Australian National Blood Authority and Blood Synergy (Monash University) during the conduct of the study. Dr. Cecconi reported receiving personal fees from Edwards Lifesciences, GE Healthcare, and Directed Systems outside the submitted work. Dr. Feldheiser reported receiving personal fees from Baxter, Medtronic, Retia, and Mindray outside the submitted work. Dr. Benes received support for article research from the Charles University research fund. Dr. Triantafyllopoulou disclosed government work. Dr Scheeren reported serving as senior medical director for Edwards Lifesciences (Garching, Germany). Dr. Piagnerelli reported receiving grants from center Federal d’Expertise Belge–KCE grant for COVID-19 study outside the submitted work. Dr. Nielsen received funding from Adrenomed and Inotrem. 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), 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. Shah’s institution received funding from the National Institute for Health and Care Research-funded Threshold for Platelet trial (131822); he received funding from Pharmacosmos U.K. and the anesthesia Editorial Board. Dr. McQuilten reported receiving grants from Australian National Blood Authority and National Health and Medical Research Council (NHMRC) during the conduct of the study. Dr. McQuilten is also supported by an NHMRC Emerging Leader Investigator Grant (GNT1194811). Monash University, Australia, received a project grant from the National Blood Authority of Australia and an NHMRC Synergy Grant (GNT1189490) for the study in Australia and New Zealand (ID508). Dr. Vlaar reported receiving support through a personal grant from the Netherlands Organization for Scientific Research, Vidi grant number 09150172010047, and funding from the Landsteiner Foundation for Blood Transfusion Research, project number 1931F. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Maier CL, Stanworth SJ, Sola-Visner M, et al.: Prophylactic platelet transfusion: Is there evidence of benefit, harm, or no effect? Transfus Med Rev 2023; 37:150751
    1. Stanworth SJ, Shah A: How I use platelet transfusions. Blood 2022; 140:1925–1936
    1. Blumberg N, Cholette JM, Schmidt AE, et al.: Management of platelet disorders and platelet transfusions in ICU patients. Transfus Med Rev 2017; 31:252–257
    1. Arnold DM, Crowther MA, Cook RJ, et al.: Utilization of platelet transfusions in the intensive care unit: Indications, transfusion triggers, and platelet count responses. Transfusion 2006; 46:1286–1291
    1. Westbrook A, Pettila V, Nichol A, et al.; Blood Observational Study Investigators of ANZICS-Clinical Trials Group: Transfusion practice and guidelines in Australian and New Zealand intensive care units. Intensive Care Med 2010; 36:1138–1146

LinkOut - more resources