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Original Research: Critical Care |

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

Shuoyan Ning, MD; Rebecca Barty, MSc; Yang Liu, MMath; Nancy M. Heddle, MSc; Bram Rochwerg, MD; Donald M. Arnold, MD
Author and Funding Information

FUNDING/SUPPORT: This work was supported by a McMaster Division of Hematology and Thromboembolism AFP research grant. McMaster Centre for Transfusion Research receives a program support award from Canadian Blood Services and Health Canada.

aDepartment of Medicine, Division of Hematology and Thromboembolism, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

bDepartment of Medicine, Division of Critical Care, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

cCanadian Blood Services, Hamilton, ON, Canada

CORRESPONDENCE TO: Donald M. Arnold MD, HSC 3V50, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):516-523. doi:10.1016/j.chest.2016.04.004
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Background  Platelet transfusions are commonly used in critically ill patients, but transfusion thresholds, count increments, and predictors of ineffectual transfusions remain unclear.

Methods  This retrospective study included consecutive adult nononcology patients who received platelet transfusions in ICUs at three Canadian academic hospitals between 2006 and 2015. Data were collected from a validated transfusion database. We determined independent predictors of ineffectual platelet transfusions, defined as transfusions that raised platelet counts by < 5 × 109/L. Reasons for transfusion were adjudicated in a subgroup of patients who underwent transfusion despite normal platelet counts.

Results  We identified 7,320 ICU admissions (n = 7,073 patients) during which 15,879 platelet transfusions were administered. Most admissions (78.7%) were for cardiac surgery. Based on 5,700 analyzable transfusions, the median pretransfusion platelet count was 87 × 109/L (interquartile range [IQR], 57-130). The pretransfusion platelet count was ≥ 50 × 109/L and ≥ 150 × 109/L for 79.6% and 17.8% of transfusions, respectively. Reasons for transfusion despite a normal platelet count were active bleeding or surgery in patients receiving antiplatelet agents or anticoagulants. The median platelet count increment was 23 × 109/L (IQR, 7-44), and 21.8% of transfusions were ineffectual. ABO incompatibility, sepsis, liver disease, and red cell and cryoprecipitate transfusions were associated with a poor platelet count increment.

Conclusions  Platelet transfusions were commonly used in the ICU when platelet counts were ≥ 50 × 109/L. One platelet transfusion increased platelet count by 23 × 109/L. One in five transfusions was ineffectual, and ABO incompatibility was identified as a modifiable risk factor. These data can help direct efforts to reduce platelet overuse and improve transfusion quality.

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