Platelet Transfusion Practices in the ICU: Data From a Large Transfusion Registry

Area of Science:

• Critical Care Medicine
• Hematology
• Transfusion Medicine

Background:

• Platelet transfusions are a common intervention for critically ill patients.
• However, optimal transfusion thresholds, expected platelet count increments, and predictors of ineffective transfusions remain poorly understood.

Purpose of the Study:

• To identify predictors of ineffectual platelet transfusions in intensive care unit (ICU) patients.
• To analyze transfusion practices and outcomes in a large cohort of critically ill patients.

Main Methods:

• A retrospective study analyzed data from 7,320 ICU admissions involving 15,879 platelet transfusions across three Canadian academic hospitals (2006-2015).
• Ineffectual transfusions were defined as those increasing platelet counts by less than 5 × 10(9)/L.
• Predictors of ineffectual transfusions and reasons for transfusion despite normal platelet counts were evaluated.

Main Results:

• The median pretransfusion platelet count was 87 × 10(9)/L, with 79.6% of transfusions given when counts were ≥ 50 × 10(9)/L.
• The median platelet count increment was 23 × 10(9)/L, and 21.8% of transfusions were ineffectual.
• ABO incompatibility, sepsis, liver disease, and concurrent red cell/cryoprecipitate transfusions were associated with poor platelet count increments.

Conclusions:

• Platelet transfusions are frequently administered in ICUs, often at higher pretransfusion counts (≥ 50 × 10(9)/L).
• A significant proportion (21.8%) of transfusions resulted in minimal platelet count increase, indicating ineffectual outcomes.
• Identifying modifiable factors like ABO incompatibility can guide strategies to optimize platelet transfusion efficacy and reduce unnecessary use.