This study by Ning et al. reports on platelet transfusion practices in 3 ICUs and includes 7073 non-oncologic patients, of whom 79% were admitted after cardiac surgery. Median pretransfusion platelet count was 87 x 10(9)/L [interquartile range 57-130] but approximatively 80% and 18% of these patients had a platelet count ≥50 x 10(9)/L and ≥150 x 10(9)/L, respectively).

The reason for transfusion was active bleeding after surgery in patients receiving antiplatelet or anticoagulant agents. Median platelet count increment was 23 x 10(9)/L (interquartile range 7-44), but 22% of transfusions were ineffective (increment lower than 5 x 10(9)/L). ABO incompatibility, sepsis, liver disease, red blood cell transfusion and cryoprecipitate transfusion were associated with poor platelet count increments.

Despite (weak) recommendations from the AABB to limit platelet transfusions in bleeding patients with thrombocytopenia and/or platelet dysfunction (Kaufman RM et al. Ann Intern Med 2015), this observational retrospective study reports a high rate of platelet transfusions (15%) in this population. Moreover, a large proportion of these patients had high platelet counts.

This study highlights the fact that platelet transfusions in the ICU requires further evaluation in prospective studies.

– Michael Piagnerelli