Sanne de Bruin

65 Transfusion practice in the bleeding critically ill; an international online survey – The TRACE-2 Survey Non-massively bleeding patients Red cell transfusion Respondents used different thresholds in different non-massively bleeding subpop- ulations (Figure 3). For the general ICU population, a Hb threshold of 7.0[7 – 7.3] g/ dL was used. This was significantly lower than for all other specified subpopulations (Figure 3A). For patients admitted with upper gastrointestinal (GI) bleeding, obstetric complications and sepsis, the reported RBC threshold was 7[7 – 8] g/dL. The highest RBC thresholds were reported for post-cardiothoracic surgery patients 8[7.9-9] g/dL. The highest variability was observed for patients on ECMO and patients with stroke and/or TBI: 7[7-9] g/dL. In patients with TBI and those post-car- diothoracic surgery, 32% of the respondents would transfuse at a Hb level of 9 g/dL or higher. In the general population, 3.5% would transfuse at a Hb level of 9 g/dL or higher. No consistent differences were observed between world regions (Additional fileal Figure S2-S7). 34%and 40%of respondents respectively reported always or most of the time checking the Hb level before administering additional RBC units. This was never checked by 8% of the respondents and sometimes by 18%. Whether the respondents would check the Hb in between transfusions did not correlate with the transfusion thresholds in any of the subpopulations (Additional file 4 figure S1). Platelet transfusion The applied platelet threshold for the general non-massively bleeding ICU population was 50 [20-50] x 10 9 /L (Figure 3B). This was similar in septic patients and patients with disseminated intravascular coagulation (DIC, p=1). Significantly higher thresholds (p<0.001) were reported in several other bleeding subpopulations including patients with upper gastrointestinal bleeding (50 [50-62] x 10 9 /L), obstetric complications (50 [50-70] x 10 9 /L), after cardio-thoracic surgery (50 [50-80] x 10 9 /L), ECMO (50 [48-80] x 10 9 /L) andwith a hemorrhagic stroke or traumatic brain injury (75 [50-100] x 10 9 /L, Figure 3B). Patients with hemorrhagic stroke or traumatic brain injury were transfused at the highest platelet count, and 31.2%of the respondents would transfuse this population to platelet levels of 100 x 10 9 /L or higher. Also, in patients receiving anti-platelet therapy, a high variance in the platelet threshold utilized was observed (50[50-100] x 10 9 /L). In these patients, 27%of the respondents would transfuse to platelet levels of 100 x 10 9 /L or higher. No consistent differences were observed between world regions (Additional file 4 Figure S2-S7). 3