Chest
Original Research: Critical CarePlatelet Transfusion Practices in the ICU: Data From a Large Transfusion Registry
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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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.