The present study was designed to evaluate the attitudes and preferences of healthcare professionals in China toward AP and WBDP. A comprehensive survey questionnaire was developed by the authors, comprising 35 questions divided into sections targeting physicians (15 questions), transfusionists (16 questions), and blood center staff (17 questions). The survey aimed to collect data on participants' basic characteristics, preferences for AP and WBDP, concerns regarding clinical application, and the acceptance of WBDP in the absence of AP. To ensure broad representation, the survey was disseminated through the WeChat Mini Program (Questionnaire Star), a prevalent digital survey platform in China, reaching healthcare institutions nationwide, including hospitals, blood centers, and local blood centers. Several questions included the ‘other’ option for free-text responses, which were reviewed by two authors and categorized, with discrepancies resolved by a panel of three additional authors. The survey questions are presented in Supplementary Tables S1–4.

A total of 781 participants completed the survey, with 86.04 % from hospitals, 10.37 % from blood centers, and 3.59 % from local blood centers, ensuring a diverse representation of healthcare professionals involved in platelet transfusion practices. The survey was conducted from November 11, 2024, to January 20, 2025, and responses were anonymized to protect participant confidentiality. The questionnaire covered key areas such as the participants' basic demographics, their preferences for AP and WBDP, concerns about the clinical use of WBDP, and their willingness to use WBDP when AP is unavailable. This broad participation ensured a comprehensive understanding of the current attitudes and practices related to platelet transfusion across different regions and types of healthcare institutions in China.

Data were analyzed using descriptive statistics (proportions, means ± SD) with Excel 2010 (Microsoft, Seattle, WA, USA) to summarize respondent characteristics, ensuring a robust and systematic approach to data collection and analysis. The survey responses were aggregated and analyzed to identify trends and patterns in healthcare professionals' attitudes toward AP and WBDP. The analysis focused on key factors influencing preferences, barriers to WBDP adoption, and strategies to enhance its acceptance. The use of descriptive statistics allowed for a clear and concise presentation of the findings, providing valuable insights into the current landscape of platelet transfusion practices in China.

A total of 781 participants from various institutions across China completed the survey, ensuring broad regional representation. The geographical distribution of respondents spanned all major regions of the country, as illustrated in Figure 1A. This distribution reflects the central role of hospitals in platelet transfusion practices, while also capturing perspectives from blood collection and distribution facilities. The institutional representation, depicted in Figure 1B, underscores the diversity of respondents, providing a comprehensive overview of attitudes and preferences across different healthcare settings.

Fig. 1.

Geographical distribution and institutional representation of survey responses across China: a nationwide analysis of 781 participants. (A) Distribution of participating institutions across different regions of China, illustrating nationwide coverage. (B) Proportion of survey participants categorized by institution type, including hospitals, blood centers, and local blood centers.

The baseline characteristics of the 781 healthcare professionals surveyed are summarized in Table 1. Of the 176 physicians, 65.91 % were female and the mean age was 35.87 ± 9.03 years. The majority held senior (30.68 %) or intermediate (33.52 %) professional titles, reflecting a well-experienced cohort. Transfusionists (n = 490) were predominantly female (68.16 %), the mean age was 40.21 ± 9.12 years, and 45.1 % held intermediate professional titles. Blood center staff (n = 115) were also mostly female (73.04 %), the mean age was 44.53 ± 9.02 years, and 45.22 % held senior professional titles. These demographics highlight the experienced and diverse nature of the respondents, ensuring that the survey results reflect informed perspectives from professional healthcare in platelet transfusion practices. Here, professional titles follow the typical hierarchy in China’s healthcare system: Junior (e.g., Resident Physician, Technician), Intermediate (e.g., Attending Physician, Supervisor Technician), and Senior (e.g., Associate Chief Physician, Chief Physician, or Senior Technician).

Physicians demonstrated a strong preference for AP over WBDP, with 78.41 % favoring AP for clinical use (Figure 2B). The primary factors influencing this preference were safety (77.54 %) and clinical efficacy (63.77 %), as shown in Figure 2C. These findings underscore the perceived reliability of AP in clinical settings, driven by its established safety profile and consistent efficacy.

Fig. 2.

Physicians’ clinical preferences, barriers, and conditional acceptance of whole blood-derived platelets (WBDP): (A) Platelet transfusion indications among patients. (B) Preference for WBDP versus apheresis platelets (AP) in clinical practice. (C) Key factors influencing physicians’ choice between WBDP and AP. (D) Percentage of physicians' willingness (Yes/No) to use WBDP when AP is unavailable. (E) Primary reasons for physicians selecting WBDP as an alternative.

When AP was unavailable, 94.32 % of physicians expressed a willingness to use WBDP as an alternative (Figure 2D). However, this acceptance was primarily driven by blood resource shortages, cited by 72.29 % of respondents as the main reason for choosing WBDP (Figure 2E).

Similarly, transfusionists exhibited an even stronger preference for AP, with 93.88 % favoring it over WBDP (Figure 3A). Key factors influencing this preference included safety (86.12 %), clinical efficacy (84.9 %), and clinician-patient rapport (68.57 %) (Figure 3B).

Fig. 3.

Transfusionists’ platelet source preferences, workload impact, and barriers to whole blood-derived platelets (WBDP) adoption. (A) Distribution of two types of platelet sources chosen by transfusionists. (B) Key factors influencing transfusionists’ decision-making. (C) Transfusionists’ acceptance (Yes/No) of WBDP as an alternative when apheresis platelets (AP) is unavailable. (D) Factors influencing transfusionists' selection of WBDP during shortages. (E) Perceived growth in workload for transfusionists due to WBDP use. (F) Primary barriers to clinical application of WBDP identified by transfusionists.

Consistent with physicians, a significant proportion of transfusionists would also select WBDP as an alternative only when AP is unavailable in clinical practice (Figure 3C). The primary factors influencing this decision were efficacy (66.67 %) and safety (60 %) (Figure 3D). While this conditional acceptance demonstrates the flexibility of transfusionists in managing platelet shortages, it also highlights the persistent concerns regarding the safety and efficacy of WBDP.

Transfusionists reported a significant increase in workload when using WBDP, with 75 % indicating additional burdens associated with its clinical application (Figure 3E). The primary barriers to WBDP adoption included concerns over transfusion reactions (92 %), safety (73.06 %), and efficacy (58.98 %) (Figure 3F).

The next series of questions was designed to understand the attitudes of the blood center staff toward the clinical equivalence of WBDP in comparison with AP. Of the survey respondents, only 31 % agreed or strongly agreed that AP and WBDP were clinically equivalent. Surprisingly, a significant proportion, 47 %, indicated that they did not have an opinion on their equivalency. Meanwhile, 19 % disagreed and 3 % strongly disagreed that the two products were clinically equivalent (Figure 4A).

Fig. 4.

Blood center staff’s perceptions of clinical equivalence and strategies for whole blood-derived platelets (WBDP) adoption. (A) Attitudes toward clinical equivalence of WBDP and apheresis platelets (AP). (B) Perceived hospital customer beliefs on equivalence. (C) Key concerns hindering WBDP adoption. (D) Proposed strategies to enhance WBDP utilization.

Blood center staff were also surveyed regarding their perceptions of hospital customers' beliefs about the clinical equivalence of WBDP and AP. Similarly, only 27 % of the respondents believed that their hospital customers would agree or strongly agree that these products are clinically equivalent, while 53 % thought their customers were either unaware or neutral on the issue. About 18 % felt that their customers did not consider the products to be equivalent (Figure 4B). The remaining respondents generally indicated that they had not specifically asked their hospital customers about their opinions, and some noted that hospitals typically relied on the blood center to decide which product to supply.

The primary barriers to the widespread adoption of WBDP, as perceived by blood center staff, included concerns over transfusion reactions (92 %), efficacy (72 %), and safety (68 %) (Figure 4C). To address these barriers, respondents identified increasing clinical research (60.87 %) and physician education (46.96 %) as key strategies for enhancing WBDP adoption (Figure 4D). Discussion

In China, AP are overwhelmingly preferred over WBDP for clinical transfusions, driven by perceptions of superior safety, efficacy, and long-term clinical experience. The efficiency of AP collection, which generates elevated platelet yields per donation, reinforces its predominance in clinical practice. Conversely, WBDP is often relegated to a secondary option, utilized only during severe blood shortages. Even then, its adoption is constrained by persistent concerns over safety and efficacy, reflecting a persistent skepticism among healthcare professionals. This preference underscores the need to address misconceptions and barriers to WBDP adoption, particularly in light of growing platelet demand and supply challenges.

The data from the present study highlight that the primary limitation to the broader acceptance of WBDP lies in the need to address persistent concerns regarding safety and efficacy. The apheresis process yields higher platelet volumes per donation, reducing donor dependency and streamlining workflows [4,10]. Despite evidence from previous studies demonstrating the clinical equivalence of WBDP and AP in safety and efficacy, this survey reveals that their adoption in China remains conditional, primarily reserved for AP shortages, due to persistent concerns among healthcare professionals. This entrenched preference for AP is sustained by longstanding perceptions of its superiority, reinforced by its standardized collection process. To address this disparity, future initiatives must prioritize evidence-based education to bridge knowledge gaps and optimize the rational use of both platelet products. While AP demonstrates marginally superior clinical CCI outcomes, WBDP remains clinically acceptable, offering cost-effective scalability to address platelet shortages [10,11] Numerous studies have demonstrated that AP and WBDP exhibit no significant differences in key safety and efficacy metrics, including rates of bacterial contamination, HLA alloimmunization, RhD alloimmunization, TRALI, and febrile non-hemolytic transfusion reactions [6,10] Despite these robust data, the current survey reveals that a significant knowledge gap persists among physicians, transfusionists, and blood center staff regarding the parity of WBDP with AP. Misconceptions driven by historical preferences for AP, limited dissemination of updated evidence, and fragmented communication between stakeholders hinder the broader adoption of WBDP.

To align practice with evidence, a tripartite collaboration among physicians, transfusionists, and blood center staff is imperative. Firstly, conducting multicenter randomized controlled trials is highly recommended to rigorously assess the clinical equivalence and CCI performance of WBDP. This strategy will provide robust and comprehensive data, ensuring that the outcomes are applicable to a diverse and representative sample of the Chinese population. Leveraging multiple centers will also allow for a broader pool of expertise and resources, thereby enhancing the reliability and credibility of the findings. Secondly, blood centers should optimize centralized WBDP production and distribution to ensure consistent quality and reduce logistical barriers. This requires upgrading infrastructure and adopting standardized protocols for large-scale WBDP preparation. Thirdly, clinical guidelines must explicitly define scenarios for AP versus WBDP use, such as prioritizing WBDP for non-sensitized patients with stable requirements and reserving AP for cases necessitating HLA-matched products or high-frequency transfusions. These guidelines should be codified into national transfusion standards and reinforced through targeted training.

Moreover, educational reforms must address systemic knowledge gaps. Integrating WBDP-focused modules into China’s centralized continuing medical education system will standardize training for physicians, transfusionists and blood center staff. Interactive workshops should emphasize practical decision-making algorithms based on patient profiles, platelet availability, and cost-benefit analyses. Concurrently, blood centers must lead quarterly symposia to update hospital teams on WBDP safety data, production advancements, and inventory management strategies. To sustain progress, institutionalized communication channels are critical. Regional transfusion committees should convene multidisciplinary teams to review WBDP utilization metrics, troubleshoot supply chain inefficiencies, and share best practices. Hospitals must establish real-time feedback mechanisms with blood centers to align production with clinical demand, while transfusionists should lead audits to monitor guideline adherence and outcomes. Encouragingly, the evolving attitudes of blood center staff, as evidenced by their active re-evaluation of WBDP’s clinical role, signal a paradigm shift. By harmonizing evidence-based education, operational collaboration, and policy reform, China can fully leverage WBDP’s potential to achieve platelet supply resilience without compromising patient care.

This study, while providing valuable insights into the perceptions and attitudes of Chinese healthcare professionals regarding platelet transfusion practices, has several limitations that warrant consideration. Firstly, the reliance on self-reported data from participants may introduce response bias, as individuals may not always accurately recall or report their preferences and experiences. Secondly, the demographic and institutional data collected were limited, lacking detailed information such as specific years of experience, exact job roles, hospital size, or blood center capacity, which could influence attitudes toward platelet transfusion practices. Thirdly, the survey was conducted over a specific period, and the findings may not capture changes in attitudes or practices over time or in response to new medical developments or policies. Fourthly, the study primarily used quantitative methods and lacked in-depth qualitative data to explore the reasons behind participants' preferences and concerns. Lastly, the study focuses on healthcare professionals' perceptions and attitudes but does not directly assess patient outcomes related to the use of AP or WBDP. Future research should address these limitations to enhance the robustness and representativeness of the findings, providing a more comprehensive understanding of platelet transfusion practices and their impact on patient care.