Chest
Volume 150, Issue 3, September 2016, Pages 516-523
Journal home page for Chest

Original Research: Critical Care
Platelet Transfusion Practices in the ICU: Data From a Large Transfusion Registry

https://doi.org/10.1016/j.chest.2016.04.004Get rights and content

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.

Section snippets

Data Source and Patient Selection

We conducted a retrospective registry study of critically ill adults (≥ 18 years) admitted to medical/surgical, cardiac, or burn ICUs at three academic centers in Hamilton, Canada between April 2006 and September 2015. Patients with cancer or chemotherapy-induced thrombocytopenia were excluded. All three hospitals had open mixed medical and surgical ICUs. One hospital was the reference center for obstetrical and perinatal patients, and one hospital was the reference center for cardiac surgery

Patients, ICU Admissions, and Platelet Transfusions

Between April 2006 and September 2015, 47,076 nononcology patients were admitted to the ICUs at three hospitals. Of these patients, 7,073 (15.0%) received 15,879 platelet transfusions (Fig 1): 31.1% of transfused patients were women with a median age of 69 years at the time of first ICU admission. Of all admissions during which platelet transfusions were administered (n = 7,320), 78.7% were for cardiac surgery. The median duration of an ICU stay was 2 days (IQR, 1-6), and overall ICU mortality

Discussion

This is the largest transfusion registry study describing platelet transfusion practices in the ICU among nononcology patients. The highest users of platelets in this cohort were patients undergoing cardiac surgery. We uncovered three key results that are of immediate importance to clinicians: (1) The expected platelet count increment after a single platelet transfusion in this population is 23 × 109/L; (2) ABO mismatched platelets are associated with poor platelet count increments; and (3)

Conclusions

In this large registry study of nononcology patients in the ICU, platelet transfusions were commonly administered for mild or moderate thrombocytopenia. One platelet transfusion resulted in a median rise in the platelet count of 23 × 109/L, and 21.8% of transfusion episodes yielded no appreciable increase in platelet count. Sepsis, liver disease, red cell and cryoprecipitate transfusion, and ABO incompatibility were associated with poor platelet count increments. The optimal use of platelet

Acknowledgments

Author contributions: S. N. and D. A. are the guarantors of the paper and contributed to research design, analysis of results, writing and editing of the paper, and approval of the final version. R. B. and Y. L. contributed to data collection, statistical analysis, editing of the paper, and approval of the final version. N. H. and B. R. contributed to editing of the paper and approval of the final version.

Financial/nonfinancial disclosures: None declared.

Role of sponsors: The sponsor had no

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