{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:14:18Z","timestamp":1777853658271,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe thrombocytopenia refractory to platelet transfusion is an increasingly common issue and poses challenges for safely performing procedures in the intensive care unit (ICU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      To describe platelet transfusion thresholds and strategies ICU clinicians use when performing invasive procedures with general low bleeding risk in patients with severe refractory thrombocytopenia (below 5000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      ), a scenario for which no current guideline recommendations exist.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional web-based survey of ICU clinicians in adult oncologic ICU<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 110 ICU clinicians 65 (59%) completed the survey (median IQR age: 36 years (31-43), 63% female). For placing a central venous catheter (CVC) majority (60%) chose a platelet transfusion threshold &lt;20\u2005000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      , while 40% chose a threshold \u226520\u2005000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      . Lower thresholds were used frequently by Fellows, APPs, and clinicians with \u22645 years experience in ICU or &lt; 50 CVC placements experience, whereas CCM attendings and more experienced clinicians favored higher thresholds (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.015). Majority (74%) transfused one unit of platelets while performing the procedure under ultrasound guidance. The internal jugular vein was the preferred site (63%). Similar strategies and platelet thresholds were employed for hemodyalisis catheter (HD) placement. Desmopressin was administered by 55% before HD catheter placement. Thirty-seven percent reported patients with platelet counts below 20\u2005000\/mm\n                      <jats:sup>3<\/jats:sup>\n                      undergoing line placement never required post-procedure transfusion for bleeding.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The survey shows that ICU clinicians are safely and comfortably performing procedures at platelet thresholds below 20,000, revealing a gap between guideline recommendations and real-world practice and a need for additional evidence to guide invasive procedures in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666261442460","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T14:28:56Z","timestamp":1776781736000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Practice Variation for Platelet Transfusion in Patients with Severe Refractory Thrombocytopenia: A Survey of Critical Care Practitioners"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-9775-3817","authenticated-orcid":false,"given":"Alina O.","family":"Dulu","sequence":"first","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6840-7988","authenticated-orcid":false,"given":"Sanjay","family":"Chawla","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center"},{"name":"Department of Anesthesiology, Weill Cornell Medical College, New York, NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neema","family":"Jayachamarajapura Onkaramurthy","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8850-7062","authenticated-orcid":false,"given":"Stephen M.","family":"Pastores","sequence":"additional","affiliation":[{"name":"Memorial Sloan Kettering Cancer Center"},{"name":"Department of Anesthesiology, Weill Cornell Medical College, New York, 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