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. 2025 Nov 24.
doi: 10.1111/vox.70153. Online ahead of print.

Multinational transfusion practices and outcomes in haematology patients admitted to the intensive care unit

Caroline M Schaap  1 , Laurens A Oomen  1 , Senta Jorinde Raasveld  1   2 , Jimmy Schenk  1   2 , Sanne de Bruin  1 , Merijn C Reuland  1 , Claudia van den Oord  1 , Jan Bakker  3   4 , Maurizio Cecconi  5 , Aarne Feldheiser  6   7 , Jens Meier  8 , Zoe McQuilten  9 , Thomas W L Scheeren  10 , Cécile Aubron  11 , Andrew W J Flint  9   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 Nielsen  37 , Harm-Jan de Grooth  38 , Alexander P J Vlaar  1 , Bart J Biemond  39 , Akshay Shah  40   41 , Marcella C A Müller  1 ; InPUT Study Group
Collaborators, Affiliations

Multinational transfusion practices and outcomes in haematology patients admitted to the intensive care unit

Caroline M Schaap et al. Vox Sang. .

Abstract

Background and objectives: The number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions.

Study design and methods: This international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and thresholds.

Results: Of 3643 ICU patients, 131 (3.6%) had a haematological condition. These patients were more likely to receive RBC (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.09-2.29) and platelet transfusions (OR 8.32, 95% CI 5.09-13.6), primarily due to low haemoglobin rather than physiological triggers. Platelet thresholds were lower (median 23 × 109/L vs. 64 × 109/L) compared to non-haematology patients. Both platelet and plasma transfusions were more frequently administered prophylactically rather than for active bleeding. Haemostatic interventions were more often used in haematology patients, at higher doses and typically without viscoelastic testing. Transfused haematology patients had higher 28-day mortality and longer ICU stays.

Conclusion: ICU patients with haematological conditions receive transfusions differently, particularly regarding platelet and plasma use. These findings underscore the need for prospective studies to define optimal transfusion thresholds in this growing and vulnerable patient population, although the study's limited sample size and lack of diagnostic granularity may affect interpretation.

Keywords: critically ill; haematological patients; intensive care unit; platelet; red blood cell; transfusion practices.

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References

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