Thrombocytopenia and guideline‐evaluated appropriateness of platelet transfusion in a tertiary care intensive care unit

Abstract

Background and ObjectivesPlatelet transfusions are common in clinical practice especially in the intensive care unit settings without acceptable clinical evidence. A retrospective audit was undertaken to evaluate the prevalence of thrombocytopenia, transfusion triggers and indications of transfusion and to assess the appropriateness of platelet transfusions based on current guidelines in patients admitted to a tertiary care intensive care unit (ICU) in South Australia.MethodsPlatelet counts on ICU admission, during ICU stay, use of platelet transfusion and clinical outcomes including bleeding for each consecutive admission to ICU over a 12‐month period was collected.ResultsThe prevalence of thrombocytopenia (platelet counts <150 × 109/l) was 51·7% in 1790 ICU patients, of which 32·4% (580/1790) were thrombocytopenic at admission while 19·4% (347/1790) of patients developed thrombocytopenia during their ICU stay. Severe thrombocytopenia with platelet counts <50 × 109/l was observed in 4·2%, with 2·6% at admission and 1·6% subsequently. Two hundred and thirteen patients (11·6%) received 480 units of platelets through 319 transfusion episodes. A total of 82·1% (262/319) of these transfusion episodes were therapeutic and 17·9% (57/319) prophylactic. Based on criteria developed from prevailing guidelines and literature, 14·1% (45/319) of platelet transfusion episodes were assessed to be inappropriate, which was 15·8% (9/57) in the prophylactic and 13·7% (36/262) in the therapeutic transfusion episodes.ConclusionThrombocytopenia is common in ICU patients, and a significant proportion of ICU patients receive platelet transfusions to control bleeding and maintain haemostasis. A minority of patients receive inappropriate platelet transfusions with unclear benefits with a potential to develop serious transfusion‐related adverse events.