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Observational Study
. 2026 Feb;121(2):169-179.
doi: 10.1111/vox.70153. Epub 2025 Nov 24.

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
Observational Study

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

Caroline M Schaap et al. Vox Sang. 2026 Feb.

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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Conflict of interest statement

Dr. Bart J. Biemond reported receiving research grants from Sanquin, Novartis, Pfizer and BMS and received honoraria for advisory board meetings/podcasts from Pfizer, Celgene, Novo Nordisk and Sanofi. Dr. Maurizio Cecconi reported receiving personal fees from Edwards Lifesciences, GE Healthcare, and Directed Systems outside the submitted work. Dr. Aarne Feldheiser reported receiving personal fees from Baxter and Medtronic outside the submitted work. Dr. Thomas W. L. Scheeren reported serving as senior medical director for Edwards Lifesciences (Garching, Germany). Dr. Zoe McQuilten reported receiving grants from the Australian National Blood Authority and National Health and Medical Research Council during the conduct of the study. Dr. Andrew W. J. Flint reported receiving grants from the Australian National Blood Authority and Blood Synergy (Monash University) during the conduct of the study. Dr. Michaël Piagnerelli reported receiving grants from Centre Federal d'Expertise Belge—KCE grant for COVID‐19 study outside the submitted work. Dr. Mohan 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. Carmen A. 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. Nathan Nielsen reported receiving personal fees from Adrenomed outside the submitted work. Dr. Alexander P. J. Vlaar reported receiving personal fees from a Vidi grant (ZonMW: 09150172010047). No other disclosures are to be reported.

Figures

FIGURE 1
FIGURE 1
Flowchart of participating countries and centres and haematological patients per continent. Figure adapted from previous International Point Prevalence Study of Intensive Care Unit Transfusion Practices (InPUT) substudy [17]. NZ, New Zealand.
FIGURE 2
FIGURE 2
Reasons and triggers for red blood cell (RBC), platelet and plasma transfusion, stratified by the presence of a haematological condition. Triggers are defined as: Physiological parameters necessitating transfusion. Reasons are defined as: Clinical reason provided for transfusion. ECG, electrocardiogram; ROTEM, rotational thromboeastometry; SCVO2, central venous oxygen saturation; SVO2, mixed venous oxygen saturation; TEG, thromboelastography.
See this image and copyright information in PMC

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