Multinational transfusion practices and outcomes in haematology patients admitted to the intensive care unit Caroline M. Schaap, Laurens A. Oomen, Senta Jorinde Raasveld, Jimmy Schenk, Sanne de Bruin, et al. Vox Sanguinis, 2026 Background and Objectives The number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions. 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 × 10 9 /L vs. 64 × 10 9 /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.
Association of anticoagulant therapy dosing with laboratory biomarkers and clinical outcomes in critically ill COVID-19 patients in the ICU Igor Vaskovic, Marija Markovic, Ljiljana Arsenovic, Aleksandra Ignjatovic, Mihailo Stojic, et al. Vojnosanitetski Pregled, 2026 Background/Aim. In immunothrombotic disorders such as coronavirus disease 2019 (COVID-19), D-dimer levels are frequently elevated, reflecting increased fibrin formation and turnover. Additional biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and levels of C-reactive protein (CRP), and lactate dehydrogenase (LDH), are associated with disease severity and outcomes. The aim of the study was to evaluate the impact of two different anticoagulation protocols on serum levels of biomarkers D-dimer, NLR, CRP, and LDH, as well as their prognostic value regarding clinical outcomes in critically ill patients with COVID-19. Methods. The retrospective study included critically ill COVID-19 patients, admitted to the Intensive Care Unit (ICU) between April 2020 and December 2021, and compared D-dimer–guided and anti-Xa–guided anticoagulation protocols. Patients were divided into two groups according to the anticoagulant therapy regimen: a group with a protocol guided by anti-Xa values (AXa group – A-XaG) and a group with a protocol dosing according to D-dimer values (D-d group – D-dG). Results. A total of 395 patients were analyzed: 137 in A-XaG and 258 in D-dG. The levels of CRP, LDH, and D-dimer were significantly lower in A-XaG compared to D-dG (p 64 years (OR: 10.215; p 395 U/L (OR: 5.491; p = 0.005) remained independently associated with mortality. Conclusion. Anti-Xa–guided anticoagulation was associated with lower inflammatory biomarker levels in ICU COVID-19 patients. While univariate analysis identified age, LDH, CRP, and D-dimer as potential prognostic factors for mortality, only age and LDH remained significant in multivariate modelling, suggesting independent prognostic value in this patient population.
The Influence of Older Age on RBC Transfusion Decisions in ICU Patients Caroline M. Schaap, Senta Jorinde Raasveld, Florian Reizine, Boillot Corentin, Jimmy Schenk, et al. Critical Care Medicine, 2026 Objectives: RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age. Design: This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study. Setting: ICUs from 233 centers across 30 countries. Data were collected from March 2019 to October 2022 in prespecified weeks. Patients: Adult ICU patients (≥ 18 yr) admitted during predefined study weeks. Patients were categorized by age (< 65, 65–75, 75–85, and > 85 yr). Interventions: None. Measurements and Main Results: A total of 3643 patients from 233 centers across 30 countries were included. Of these, 53% were younger than 65 years, 26% were 65–75 years, 17% were 75–85 years, and 4% were older than 85 years. RBC transfusion rates ranged from 23% to 26% across all age groups ( p = 0.91). Patients older than 85 years had higher stated hemoglobin thresholds (median, 10.0 g/dL) compared with younger patients (median, 8.0 g/dL; p < 0.001). “Age” and “improve general state” were more frequently cited as reasons for transfusion in patients older than 85 years. However, after adjustment, age was not associated with the probability of receiving an RBC transfusion. Conclusions: Different transfusion strategies are applied in patients older than 85 years old. These differences appear to be driven by age-related differences in physiology and diagnoses rather than motivated by older age itself.
Global transfusion practices in septic patients in the intensive care unit: insights from the InPUT-study sub-analysis Vincent C. Kurucz, Andrew W. J. Flint, Alexis Poole, Merijn C. Reuland, Claudia van den Oord, et al. Transfusion, 2025 Background Transfusion practices among intensive care unit (ICU) patients with sepsis vary widely. While restrictive hemoglobin thresholds for red blood cell (RBC) transfusion are well studied, the indications and thresholds for platelet and plasma transfusions remain uncertain. Methods We performed a sepsis‐specific sub‐analysis of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices , a prospective, multicenter, observational study capturing all adult ICU admissions during four pre‐scheduled weeks between March 2019 and October 2022. Patients admitted with sepsis or septic shock, or who developed sepsis during their ICU stay, were included. We recorded demographics, daily laboratory values, and transfusion triggers. Primary endpoints were the proportions of patients receiving RBCs, platelets, or plasma; secondary endpoints were indications, pre‐transfusion thresholds, and blood loss. Results Among 3643 screened patients, 799 (22%) fulfilled sepsis criteria; within this subgroup, 317 (40%) received at least one blood component. RBCs were transfused in 269 patients (34%), primarily to address anemia or hemodynamic instability, at a mean pre‐transfusion hemoglobin of 7.5 ± 1.4 g/dL, consistent with restrictive practice. Platelets were given to 78 patients (10%) for prophylaxis or active bleeding at a median count of 26 × 10 9 cells/L (interquartile range 16–51 × 10 9 cells/L). Plasma was administered to 108 patients (14%), half for bleeding control and half for non‐bleeding indications. Conclusions This largest international snapshot of septic ICU transfusion practices confirms adherence to restrictive RBC thresholds but reveals substantial variability in platelet and plasma use. These findings underscore the need for targeted trials to refine transfusion guidelines in sepsis.
Platelet Transfusion Practices in the ICU: A Prospective Multicenter Cohort Study Stefan F. van Wonderen, Senta Jorinde Raasveld, Andrew W. J. Flint, Jimmy Schenk, Claudia van den Oord, et al. Critical Care Medicine, 2025 Objective: There is a lack of comprehensive international data regarding platelet transfusion practices in the ICU. This study aimed to evaluate the current occurrence rate of platelet transfusion in the ICU and provide an overview of platelet transfusion practices including indications for a platelet transfusion, thresholds, (non-)adherence and geo-economic region variations. Design: International prospective cohort study. Setting: Two hundred thirty-three centers in 30 countries worldwide. Patients: All patients 18 years old and older, admitted to the ICU during a single study week, selected by each site from one of the 16 predefined weeks (March 2019 to October 2022), were included. Interventions: None. Measurements and Main Results: Of the 3643 patients, 208 (6%) received a platelet transfusion during their ICU stay and main indications consisted of active bleeding (42%, n = 187/443), prophylaxis (33%, n = 144/443) or an upcoming procedure (12%, n = 51/443). The median platelet count before transfusion was 44 × 10 9 /L (interquartile range [IQR], 20–78) with variation by indication, including a higher median of 60 × 10 9 /L (IQR 31–93) during active bleeding. A threshold for transfusion was stated in 51% ( n = 224/443) of the events, with a median threshold platelet count of 50 × 10 9 /L (IQR, 40–100). The advised threshold was not adhered to in 16% ( n = 36/224) of cases, with the majority having active bleeding as indication. Contrasts in transfusion practices were observed across different geo-economic regions. Platelet transfusions were administered to 6% ( n = 156/2520) of patients in high-income countries, 5% ( n = 52/1069) of patients in upper-middle-income countries and in none from lower-middle-income countries ( n = 0/54). Non-adherence was higher in the high-income countries (23%, n = 34/149) than upper-middle-income countries (3%, n = 2/75). Conclusions: Platelet transfusions were administered to a small proportion of critically ill patients, and were given to treat active bleeding or as prophylaxis in the majority of cases. Occurence rate, indication and threshold adherence for platelet transfusion widely varied between geo-economic regions.
