Sanne de Bruin

27 Transfusion practice in the non-bleeding critically ill; an international online survey – The TRACE Survey Introduction As critically ill patients frequently develop anaemia, thrombocytopenia or coagulopa- thy 1–3 , transfusion of blood components is a frequent intervention in the intensive care unit (ICU). About 12.5%of all transfused red cell concentrates (RCCs), 13%of all platelet concentrates (PC) and 30%of all plasma units in the hospital are transfused in the ICU 4 . However these products are associated with life threatening adverse events including transfusion related acute lung injury (TRALI), transfusion associated cardiac overload (TACO), and transfusion related immunomodulation(TRIM) 5–7 . Since the Transfusion Requirements in Critical Care (TRICC) trial, 20 years ago, it has been increasingly recognized that a restrictive RCC transfusion strategy may be as safe as a liberal strategy and even reduce patient mortality in specific patient subpopu- lations 8 . Consequently, ICU transfusion practice has shifted towards more restrictive strategies. From 2002 to 2012, the incidence of RCC transfusion in critically ill patients has dropped from 37% 9 to 26% 1 during ICU admission. This reduction coincided with the publication of multiple large international randomized controlled trials (RCTs) showing the safety of a restrictive transfusion strategy 8,10,11 . While multiple large RCTs have been performed to compare liberal versus restrictive strategies in red blood cell transfusions in ICUs, RCTs studying the optimal transfusion strategies in critically ill patients for plasma and platelets are limited or had a small sample size 12 . It is difficult to judge what “appropriate” transfusion triggers are for these blood products. This uncertainty is reflected in poor adherence to recommended best practices. It is estimated that hospital wide 37% of transfused plasma units and 33% of transfused platelets are administered outside guideline recommendations 13–15 . Of note there is no international ICU transfusion guideline. The aim of this survey was to evaluate the use of local transfusion guidelines in the ICU and the applied transfu- sion thresholds for RCC, PLT and plasma transfusion in ICU patients without an active haemorrhage. Methods Survey An anonymous survey on transfusion practices in non-bleeding patients was conducted among intensivists, intensivist in training and non-intensivists specialists attending in 2