BACKGROUND: Transfusion practices among intensive care unit (ICU) patients with sepsis vary widely. While restrictive hemoglobin thresholds for red blood cell (RBC) transfusion are well studied, the indications and thresholds for platelet and plasma transfusions remain uncertain. METHODS: We performed a sepsis-specific sub-analysis of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices, a prospective, multicenter, observational study capturing all adult ICU admissions during four pre-scheduled weeks between March 2019 and October 2022. Patients admitted with sepsis or septic shock, or who developed sepsis during their ICU stay, were included. We recorded demographics, daily laboratory values, and transfusion triggers. Primary endpoints were the proportions of patients receiving RBCs, platelets, or plasma; secondary endpoints were indications, pre-transfusion thresholds, and blood loss. RESULTS: Among 3643 screened patients, 799 (22%) fulfilled sepsis criteria; within this subgroup, 317 (40%) received at least one blood component. RBCs were transfused in 269 patients (34%), primarily to address anemia or hemodynamic instability, at a mean pre-transfusion hemoglobin of 7.5 ± 1.4 g/dL, consistent with restrictive practice. Platelets were given to 78 patients (10%) for prophylaxis or active bleeding at a median count of 26 × 109 cells/L (interquartile range 16-51 × 109 cells/L). Plasma was administered to 108 patients (14%), half for bleeding control and half for non-bleeding indications. CONCLUSIONS: This largest international snapshot of septic ICU transfusion practices confirms adherence to restrictive RBC thresholds but reveals substantial variability in platelet and plasma use. These findings underscore the need for targeted trials to refine transfusion guidelines in sepsis.

Department for Internal Intensive Care General Hospital Celje Medical Faculty University of Ljubljana Ljubljana 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 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 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 Intensive Care Utrecht University Medical Centers Utrecht The Netherlands

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

Department of Pulmonary and Critical Care New York University New York New York USA

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

Faculty of Medicine University of Tripoli Tripoli Libya

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 UK

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

Transfusion Research Unit School of Public Health and Preventive Medicine Monash University Melbourne Australia

Unidad de Cuidados Intensivos Hospital Vicente Corral Moscoso Cuenca Ecuador

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