Sanne de Bruin

211 General discussion The aims of this thesis Research on transfusion practice has gained considerable traction in recent years. Im- proving transfusion practice involves adequate guidelines for physicians and awareness of the benefits and potential adverse effects of transfusion. It also includes research to improve storage conditions, providing the basis for safer and more efficient blood products. Transfusion practice is becoming more and more restrictive in order to limit the potential harmful adverse effects of transfusion in patients. Simultaneously, blood products are constantly being improved. This thesis focused on several aspects of the current transfusion research field, including the following key aspects: 1. To study transfusion practice and transfusion triggers on the ICU 2. To design a study protocol in which transfusion practice is evaluated, including the use of transfusion triggers other than laboratory values. 3. To assess whether storage of RBCs in an alkaline additive solution resulted in a higher post transfusion recovery and better metabolic restoration after transfusion. 4. To develop a standardized method to label platelets with biotin, a product that can be used to asses post transfusion platelet recovery, even in vulnerable patient populations. Transfusion practice on the Intensive care unit (ICU) In chapter 2-4 clinical practice in critically ill patients is assessed in two surveys among physicians working on the ICU and one small prospective cohort study with 48 critically ill patients. One of our main findings is that RBC transfusion is restrictive in most ICU subpopulations. However, the clinical practice of platelet and plasma transfusion is more heterogeneous and less restrictive. In this thesis we showed a continuation of the trend towards a more restrictive transfu- sion strategy for red blood cell transfusion practices with the exception of different sub- populations. Patients with acute myocardial infarction were transfused at significantly higher Hb levels compared to other patient populations. This is in line with current guidelines that recommend a liberal transfusion strategy for patients with acute coro- nary syndrome 1–3 . Consequently, these patients are excluded in large RCTs comparing different transfusion strategies. Recently, the REALITY trial showed that in anaemic patients with acute coronary syndrome a restrictive transfusion strategy (Hb threshold 8g/dL) was non-inferior compared with a liberal transfusion strategy (Hb threshold of 9