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 × 10 9 /L (interquartile range [IQR], 20-78) with variation by indication, including a higher median of 60 × 10 9 /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 × 10 9 /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.

Department for Internal Intensive Care General Hospital Celje Medical Faculty University of Ljubljana Celje Slovenia

Department of Anaesthesiology Intensive Care Medicine and Pain Therapy EvangKliniken Essen Mitte Huyssens Stiftung Knappschaft Essen Germany

Department of Anesthesia and Intensive Care Medicine Copenhagen University Hospital Gentofte Hellerup Denmark

Department of Anesthesia and Intensive Care Military Medical Academy Belgrade Belgrade Serbia

Department of Anesthesiology Aga Khan University Hospital Nairobi Kenya

Department of Anesthesiology Amsterdam University Medical Centers Amsterdam The Netherlands

Department of Anesthesiology and Intensive Care Institute of Medical Sciences University of Opole Opole Poland

Department of Anesthesiology and Intensive Care IRCCS Humanitas Research Hospital Milan Italy

Department of Anesthesiology and Intensive Care Kepler University Clinic Kepler University Linz Austria

Department of Anesthesiology and Intensive Care Medicine University Hospital and Faculty of Medicine in Plzen Charles University Plzen Czech Republic

Department of Anesthesiology and Intensive Care University Clinical Hospital Center Zagreb Zagreb Croatia

Department of Anesthesiology and Post surgical Critical Care University Hospital Doctor Peset Valencia Spain

Department of Anesthesiology and Reanimation Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center University of Health Sciences Istanbul Turkey

Department of Anesthesiology Critical Care and Pain Tata Memorial Hospital Homi Bhabha National Institute Mumbai Maharashtra India

Department of Anesthesiology University Medical Center Groningen Groningen The Netherlands

Department of Cardiothoracic Surgery European Interbalkan Medical Center Thessaloniki Greece

Department of Child General and Specialistic Surgery University of Campania Luigi Vanvitelli Naples Italy

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Clinical Science and Education Södersjukhuset Karolinska Institutet Stockholm Sweden

Department of Critical Care Asgar Ali Hospital Dhaka Bangladesh

Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow Uttar Pradesh India

Department of Epidemiology and Data Science Amsterdam University Medical Centre location AMC Amsterdam Public Health University of Amsterdam Amsterdam The Netherlands

Department of Intensive Care Adults Erasmus MC University Medical Centers Rotterdam The Netherlands

Department of Intensive Care Amsterdam University Medical Centers Amsterdam The Netherlands

Department of Intensive Care Centro Hospitalar de Entro o Douro e Vouga Santa Maria da Feira Portugal

Department of Intensive Care CHU Charleroi Marie Curie Université Libre de Brussels Charleroi Belgium

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Copenhagen Denmark

Department of Intensive Care Inselspital Bern University Hospital and University of Bern Bern Switzerland

Department of Intensive Care Pontificia Universidad Católica de Chile Santiago Chile

Department of Pulmonary and Critical Care New York University and Columbia University New York NY

Division of Pulmonary Critical Care and Sleep Medicine and Section of Transfusion Medicine and Therapeutic Pathology University of New Mexico School of Medicine Albuquerque NM

Faculty of Medicine University of Tripoli Tripoli Libya

Intensive Care Center University Medical Center Utrecht Utrecht The Netherlands

Intensive Care Service Hospital Universitario La Paz Madrid Spain

Intensive Care Unit 1st Department of Respiratory Medicine National and Kapodistrian University of Athens Sotiria Chest Hospital Athens Greece

Médecine Intensive Réanimation CHU de Brest Université de Bretagne Occidentale Brest France

Nuffield Department of Clinical Neurosciences University of Oxford Oxford United Kingdom

School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

The Australian and New Zealand Intensive Care Research Centre School of Public Health and Preventive Medicine Monash University Melbourne VIC Australia

Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador

Zobrazit více v PubMed

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. PubMed

Stanworth SJ, Shah A: How I use platelet transfusions. Blood. 2022; 140:1925–1936 PubMed

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 PubMed

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 PubMed

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 PubMed

Stanworth SJ, Walsh TS, Prescott RJ, et al. ; Intensive Care Study of Coagulopathy Investigators: Thrombocytopenia and platelet transfusion in UK critical care: A multicenter observational study. Transfusion. 2013; 53:1050–1058 PubMed

Ning S, Barty R, Liu Y, et al. : Platelet transfusion practices in the ICU: Data from a large transfusion registry. Chest. 2016; 150:516–523 PubMed

Anthon CT, Pène F, Perner A, et al. : Thrombocytopenia and platelet transfusions in ICU patients: An international inception cohort study (PLOT-ICU). Intensive Care Med. 2023; 49:1327–1338 PubMed PMC

Holcomb JB, Tilley BC, Baraniuk S, et al. ; PROPPR Study Group: Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA. 2015; 313:471–482 PubMed PMC

van Baarle FLF, van de Weerdt EK, van der Velden W, et al. : Platelet transfusion before CVC placement in patients with thrombocytopenia. N Engl J Med. 2023; 388:1956–1965 PubMed

Stanworth SJ, Estcourt LJ, Powter G, et al. ; TOPPS Investigators: A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med. 2013; 368:1771–1780 PubMed

Vlaar APJ, Dionne JC, de Bruin S, et al. : Transfusion strategies in bleeding critically ill adults: A clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2021; 47:1368–1392 PubMed PMC

Vlaar AP, Oczkowski S, de Bruin S, et al. : Transfusion strategies in non-bleeding critically ill adults: A clinical practice guideline from the European Society of Intensive Care Medicine. Intensive Care Med. 2020; 46:673–696 PubMed PMC

Metcalf RA, Nahirniak S, Guyatt G, et al. : Platelet transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines. JAMA. 2025; 334:606–617 PubMed

Kaufman RM, Djulbegovic B, Gernsheimer T, et al. ; AABB: Platelet transfusion: A clinical practice guideline from the AABB. Ann Intern Med. 2015; 162:205–213 PubMed

Estcourt LJ, Birchall J, Allard S, et al. ; British Committee for Standards in Haematology: Guidelines for the use of platelet transfusions. Br J Haematol. 2017; 176:365–394 PubMed

Peju E, Llitjos JF, Charpentier J, et al. : Impact of blood product transfusions on the risk of ICU-acquired infections in septic shock. Crit Care Med. 2021; 49:912–922 PubMed

Engele LJ, Straat M, van Rooijen IHM, et al. ; MARS Consortium: Transfusion of platelets, but not of red blood cells, is independently associated with nosocomial infections in the critically ill. Ann Intensive Care. 2016; 6:67. PubMed PMC

Aubron C, Flint AW, Bailey M, et al. : Is platelet transfusion associated with hospital-acquired infections in critically ill patients? Crit Care. 2017; 21:2. PubMed PMC

Narayan S. (Ed) Poles D. et al. ; on behalf of the Serious Hazards of Transfusion (SHOT) Steering Group. The 2021 Annual SHOT Report (2022).

Wandt H, Schaefer-Eckart K, Wendelin K, et al. ; Study Alliance Leukemia: Therapeutic platelet transfusion versus routine prophylactic transfusion in patients with haematological malignancies: An open-label, multicentre, randomised study. Lancet. 2012; 380:1309–1316 PubMed

Warner MA, Chandran A, Frank RD, et al. : Prophylactic platelet transfusions for critically ill patients with thrombocytopenia: A single-institution propensity-matched cohort study. Anesth Analg. 2019; 128:288–295 PubMed PMC

Salman SS, Fernandez Perez ER, Stubbs JR, et al. : The practice of platelet transfusion in the intensive care unit. J Intensive Care Med. 2007; 22:105–110 PubMed

Schiffer CA, Bohlke K, Delaney M, 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

de Bruin S, Scheeren TWL, Bakker J, et al. : Transfusion practice in the non-bleeding critically ill: An international online survey—the TRACE survey. Crit Care. 2019; 23:309. PubMed PMC

de Bruin S, Eggermont D, van Bruggen R, et al. ; Cardiovascular Dynamics Section and Transfusion Task Force of the ESICM: Transfusion practice in the bleeding critically ill: An international online survey—the TRACE-2 survey. Transfusion. 2022; 62:324–335 PubMed PMC

Raasveld SJ, de Bruin S, Reuland MC, et al. ; InPUT Study Group: Red blood cell transfusion in the intensive care unit. JAMA. 2023; 330:1852–1861 PubMed PMC

The World Bank: World Bank Country and Lending Groups. Available at: https://data.worldbank.org/. Accessed August 28, 2023

Roberts N, James S, Delaney M, et al. : The global need and availability of blood products: A modelling study. Lancet Haematol. 2019; 6:e606–e615 PubMed

Roberts DJ, Field S, Delaney M, et al. : Problems and approaches for blood transfusion in the developing countries. Hematol Oncol Clin North Am. 2016; 30:477–495 PubMed

Custer B, Zou S, Glynn SA, et al. : Addressing gaps in international blood availability and transfusion safety in low- and middle-income countries: A NHLBI workshop. Transfusion. 2018; 58:1307–1317 PubMed PMC

Barnes LS, Stanley J, Bloch EM, et al. ; AABB Global Transfusion Forum: Status of hospital-based blood transfusion services in low-income and middle-income countries: A cross-sectional international survey. BMJ Open. 2022; 12:e055017 PubMed PMC

Warner MA, Shore-Lesserson L, Burns C: From product to patient-transfusion and patient blood management. JAMA. 2023; 330:1837–1838 PubMed