Plasma transfusion in the intensive care unit

Maite M.T. van Haeren; Senta Jorinde Raasveld; the InPUT Study Group; Sanne de Bruin; Merijn C. Reuland; Claudia van den Oord; Jimmy Schenk; Cécile Aubron; Jan Bakker; Maurizio Cecconi; Aarne Feldheiser; Harm Jan de Grooth; Jens Meier; Thomas W.L. Scheeren; Zoe McQuilten; Andrew Flint; Tarikul Hamid; Michaël Piagnerelli; Tina Tomić Mahečić; Jan Benes; Lene Russell; Hernan Aguirre-Bermeo; Konstantina Triantafyllopoulou; Vasiliki Chantziara; Mohan Gurjar; Sheila Nainan Myatra; Vincenzo Pota; Muhammed Elhadi; Ryszard Gawda; Mafalda Mourisco; Marcus Lance; Vojislava Neskovic; Matej Podbregar; Juan V. Llau; Manual Quintana-Diaz; Maria Cronhjort; Carmen A. Pfortmueller; Nihan Yapici; Nathan D. Nielsen; Akshay Shah; Alexander P.J. Vlaar; Marcella C.A. Müller

doi:10.1111/trf.18071

Plasma transfusion in the intensive care unit

Maite M.T. van Haeren, Senta Jorinde Raasveld, the InPUT Study Group, Sanne de Bruin, Merijn C. Reuland, Claudia van den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Aarne Feldheiser, Harm Jan de Grooth, Jens Meier, Thomas W.L. Scheeren, Zoe McQuilten, Andrew Flint, Tarikul Hamid, Michaël Piagnerelli, Tina Tomić Mahečić, Jan BenesLene Russell, Hernan Aguirre-Bermeo, Konstantina Triantafyllopoulou, Vasiliki Chantziara, Mohan Gurjar, Sheila Nainan Myatra, Vincenzo Pota, Muhammed Elhadi, Ryszard Gawda, Mafalda Mourisco, Marcus Lance, Vojislava Neskovic, Matej Podbregar, Juan V. Llau, Manual Quintana-Diaz, Maria Cronhjort, Carmen A. Pfortmueller, Nihan Yapici, Nathan D. Nielsen, Akshay Shah, Alexander P.J. Vlaar, Marcella C.A. Müller^*

^*Corresponding author for this work

Intensive Care

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background:

Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods:

This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results:

Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5.

Discussion:

Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

Original language	English
Pages (from-to)	73-87
Number of pages	15
Journal	Transfusion
Volume	65
Issue number	1
DOIs	https://doi.org/10.1111/trf.18071
Publication status	Published - Jan 2025

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Publisher Copyright:
© 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.

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van Haeren, M. M. T., Raasveld, S. J., the InPUT Study Group, de Bruin, S., Reuland, M. C., van den Oord, C., Schenk, J., Aubron, C., Bakker, J., Cecconi, M., Feldheiser, A., de Grooth, H. J., Meier, J., Scheeren, T. W. L., McQuilten, Z., Flint, A., Hamid, T., Piagnerelli, M., Mahečić, T. T., ... Müller, M. C. A. (2025). Plasma transfusion in the intensive care unit. Transfusion, 65(1), 73-87. https://doi.org/10.1111/trf.18071

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title = "Plasma transfusion in the intensive care unit",

abstract = "Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. Discussion: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.",

author = "{van Haeren}, {Maite M.T.} and Raasveld, {Senta Jorinde} and {the InPUT Study Group} and {de Bruin}, Sanne and Reuland, {Merijn C.} and {van den Oord}, Claudia and Jimmy Schenk and C{\'e}cile Aubron and Jan Bakker and Maurizio Cecconi and Aarne Feldheiser and {de Grooth}, {Harm Jan} and Jens Meier and Scheeren, {Thomas W.L.} and Zoe McQuilten and Andrew Flint and Tarikul Hamid and Micha{\"e}l Piagnerelli and Mahe{\v c}i{\'c}, {Tina Tomi{\'c}} and Jan Benes and Lene Russell and Hernan Aguirre-Bermeo and Konstantina Triantafyllopoulou and Vasiliki Chantziara and Mohan Gurjar and Myatra, {Sheila Nainan} and Vincenzo Pota and Muhammed Elhadi and Ryszard Gawda and Mafalda Mourisco and Marcus Lance and Vojislava Neskovic and Matej Podbregar and Llau, {Juan V.} and Manual Quintana-Diaz and Maria Cronhjort and Pfortmueller, {Carmen A.} and Nihan Yapici and Nielsen, {Nathan D.} and Akshay Shah and Vlaar, {Alexander P.J.} and M{\"u}ller, {Marcella C.A.} and {van Haeren}, {Maite M.T.} and Raasveld, {Senta Jorinde} and {de Bruin}, Sanne and Reuland, {Merijn C.} and {van den Oord}, Claudia and Jimmy Schenk and C{\'e}cile Aubron and Jan Bakker and Maurizio Cecconi",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s). Transfusion published by Wiley Periodicals LLC on behalf of AABB.",

year = "2025",

month = jan,

doi = "10.1111/trf.18071",

language = "English",

volume = "65",

pages = "73--87",

journal = "Transfusion",

issn = "0041-1132",

publisher = "John Wiley & Sons Inc.",

number = "1",

}

van Haeren, MMT, Raasveld, SJ, the InPUT Study Group, de Bruin, S, Reuland, MC, van den Oord, C, Schenk, J, Aubron, C, Bakker, J, Cecconi, M, Feldheiser, A, de Grooth, HJ, Meier, J, Scheeren, TWL, McQuilten, Z, Flint, A, Hamid, T, Piagnerelli, M, Mahečić, TT, Benes, J, Russell, L, Aguirre-Bermeo, H, Triantafyllopoulou, K, Chantziara, V, Gurjar, M, Myatra, SN, Pota, V, Elhadi, M, Gawda, R, Mourisco, M, Lance, M, Neskovic, V, Podbregar, M, Llau, JV, Quintana-Diaz, M, Cronhjort, M, Pfortmueller, CA, Yapici, N, Nielsen, ND, Shah, A, Vlaar, APJ & Müller, MCA 2025, 'Plasma transfusion in the intensive care unit', Transfusion, vol. 65, no. 1, pp. 73-87. https://doi.org/10.1111/trf.18071

TY - JOUR

T1 - Plasma transfusion in the intensive care unit

AU - van Haeren, Maite M.T.

AU - Raasveld, Senta Jorinde

AU - the InPUT Study Group

AU - de Bruin, Sanne

AU - Reuland, Merijn C.

AU - van den Oord, Claudia

AU - Schenk, Jimmy

AU - Aubron, Cécile

AU - Bakker, Jan

AU - Cecconi, Maurizio

AU - Feldheiser, Aarne

AU - de Grooth, Harm Jan

AU - Meier, Jens

AU - Scheeren, Thomas W.L.

AU - McQuilten, Zoe

AU - Flint, Andrew

AU - Hamid, Tarikul

AU - Piagnerelli, Michaël

AU - Mahečić, Tina Tomić

AU - Benes, Jan

AU - Russell, Lene

AU - Aguirre-Bermeo, Hernan

AU - Triantafyllopoulou, Konstantina

AU - Chantziara, Vasiliki

AU - Gurjar, Mohan

AU - Myatra, Sheila Nainan

AU - Pota, Vincenzo

AU - Elhadi, Muhammed

AU - Gawda, Ryszard

AU - Mourisco, Mafalda

AU - Lance, Marcus

AU - Neskovic, Vojislava

AU - Podbregar, Matej

AU - Llau, Juan V.

AU - Quintana-Diaz, Manual

AU - Cronhjort, Maria

AU - Pfortmueller, Carmen A.

AU - Yapici, Nihan

AU - Nielsen, Nathan D.

AU - Shah, Akshay

AU - Vlaar, Alexander P.J.

AU - Müller, Marcella C.A.

AU - van Haeren, Maite M.T.

AU - Raasveld, Senta Jorinde

AU - de Bruin, Sanne

AU - Reuland, Merijn C.

AU - van den Oord, Claudia

AU - Schenk, Jimmy

AU - Aubron, Cécile

AU - Bakker, Jan

AU - Cecconi, Maurizio

PY - 2025/1

Y1 - 2025/1

N2 - Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. Discussion: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

AB - Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines. Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications. Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% of total transfusion events. A median of 2 (IQR 1, 2) units was given per event excluding massive transfusion protocol (MTP) and 3 (IQR 2, 6) when MTP was activated. MTP accounted for 39 (7%) of events. Indications of non-MTP events included active bleeding (54%), prophylactic (25%), and pre-procedure (12%). Target INR/PT was stated for 43% of transfusion events; pre-transfusion INR/PT or visco-elastic hemostatic assays (VHA) were reported for 73%. Thirty-seven percent of events were administered for non-bleeding indications, 54% with a pre-transfusion INR < 3.0 and 30% with an INR < 1.5. Discussion: Plasma transfusions occurred in 10% of ICU patients. Over a third were given for non-bleeding indications and might have been avoidable. Target INR/PT was not stated in more than half of transfusions, and pre-transfusion INR/PT or VHA was not reported for 27%. Further research and education is needed to optimize guideline implementation and to identify appropriate indications for plasma transfusion.

UR - http://www.scopus.com/inward/record.url?scp=85212693976&partnerID=8YFLogxK

U2 - 10.1111/trf.18071

DO - 10.1111/trf.18071

M3 - Article

C2 - 39696779

AN - SCOPUS:85212693976

SN - 0041-1132

VL - 65

SP - 73

EP - 87

JO - Transfusion

JF - Transfusion

IS - 1

ER -

Plasma transfusion in the intensive care unit

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