Multinational transfusion practices and outcomes in haematology patients admitted to the intensive care unit.
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Schaap Caroline M, Oomen Laurens A, Raasveld Senta Jorinde, Schenk Jimmy, de Bruin Sanne, Reuland Merijn C, van den Oord Claudia, Bakker Jan, Cecconi Maurizio, Feldheiser Aarne, Meier Jens, McQuilten Zoe, Scheeren Thomas W L, Aubron Cécile, Flint Andrew W J, Hamid Tarikul, Piagnerelli Michaël, Mahečić Tina Tomić, Benes Jan, Russell Lene, Aguirre-Bermeo Hernan, Triantafyllopoulou Konstantina, Chantziara Vasiliki, Gurjar Mohan, Myatra Sheila Nainan, Pota Vincenzo, Elhadi Muhammed, Gawda Ryszard, Mourisco Mafalda, Lance Marcus, Neskovic Vojislava, Podbregar Matej, Llau Juan V, Quintana-Diaz Manual, Cronhjort Maria, Pfortmueller Carmen A, Yapici Nihan, Nielsen Nathan, de Grooth Harm-Jan, Vlaar Alexander P J, Biemond Bart J, Shah Akshay, Müller Marcella C A, InPUT Study Group
Аннотация
STUDY DESIGN AND METHODS: This international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and thresholds.
RESULTS: Of 3643 ICU patients, 131 (3.6%) had a haematological condition. These patients were more likely to receive RBC (odds ratio [OR] 1.58, 95% confidence interval [CI] 1.09-2.29) and platelet transfusions (OR 8.32, 95% CI 5.09-13.6), primarily due to low haemoglobin rather than physiological triggers. Platelet thresholds were lower (median 23 × 109/L vs. 64 × 109/L) compared to non-haematology patients. Both platelet and plasma transfusions were more frequently administered prophylactically rather than for active bleeding. Haemostatic interventions were more often used in haematology patients, at higher doses and typically without viscoelastic testing. Transfused haematology patients had higher 28-day mortality and longer ICU stays.
CONCLUSION: ICU patients with haematological conditions receive transfusions differently, particularly regarding platelet and plasma use. These findings underscore the need for prospective studies to define optimal transfusion thresholds in this growing and vulnerable patient population, although the study's limited sample size and lack of diagnostic granularity may affect interpretation.