Fresh frozen plasma transfusion in critically ill patients*

Objectives:Although guidelines for fresh frozen plasma (FFP) use have been published, many transfusions are considered inappropriate. Current guidelines suggest few circumstances in which FFP transfusion to critically ill patients is warranted. The objectives of this study were to evaluate the consistency of Canadian guidelines for FFP administration to critically ill patients and to examine factors associated with inappropriate FFP transfusions. Design:Retrospective cohort study. Setting:15-bed medical surgical intensive care unit in a teaching hospital. Patients:254 consecutive adults admitted during 1 yr expected to stay in intensive care for more than 72 hrs. Intervention:None. Measurements and Main Results:Patient demographics, illness severity, life support, intensive care and hospital length of stay, and survival were prospectively collected. All FFP orders were identified from the hospital laboratory information system. For each order, coagulation parameters, planned invasive interventions, recent or current bleeding, and bleeding severity were retrospectively collected. Three observers independently adjudicated whether transfusions were consistent with guidelines, inconsistent but appropriate for the intensive care context, or inappropriate. Of 254 patients, 76 (29.9%) received FFP, accounting for 225 orders to transfuse 547 units. Of 225 orders, 73 (32.4%) were consistent with guidelines, 45 (20.0%) were inconsistent but appropriate, and 107 (47.6%) were inappropriate. Considering transfusions clustered within patients, chance-independent agreement on whether transfusions were inappropriate or not was high (phi 0.73, 0.64–0.81). Independent determinants of inappropriate FFP were the presence of less severe coagulopathy as indicated by lower international normalized ratios (p < .0001) and the absence of bleeding (p < .0001) of planned invasive procedure (p = .0001). Conclusions:Critically ill patients frequently receive inappropriate FFP transfusions. Many transfusions may be appropriate for the intensive care setting, although they are inconsistent with expert recommendations, highlighting that further studies are needed to assess the effectiveness and safety of FFP transfusion in critical illness.

[1]  B. Healy,et al.  Effect of fresh‐frozen plasma transfusion on prothrombin time and bleeding in patients with mild coagulation abnormalities , 2006, Transfusion.

[2]  Bekele Afessa,et al.  Fresh frozen plasma transfusion in critically ill medical patients with coagulopathy* , 2005, Critical care medicine.

[3]  G. Guyatt,et al.  Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors , 2005, Critical care medicine.

[4]  S. Dzik,et al.  Is fresh frozen plasma overtransfused in the United States? , 2004, Transfusion.

[5]  J. S. St. Sauver,et al.  Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation* , 2004, Critical care medicine.

[6]  S. Brunskill,et al.  Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials , 2004, British journal of haematology.

[7]  J. Duguid,et al.  Guidelines for the use of fresh‐frozen plasma, cryoprecipitate and cryosupernatant , 2004, British journal of haematology.

[8]  A. Casbard,et al.  The role of prophylactic fresh frozen plasma in decreasing blood loss and correcting coagulopathy in cardiac surgery. A systematic review , 2004, Anaesthesia.

[9]  G. Findlay,et al.  Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients , 2004, British journal of haematology.

[10]  R. Tait,et al.  A two‐phase audit of fresh frozen plasma: a regional approach , 2004, Transfusion medicine.

[11]  K. Wilson,et al.  The effectiveness of interventions to reduce physician's levels of inappropriate transfusion: what can be learned from a systematic review of the literature , 2002, Transfusion.

[12]  I. Chin-Yee,et al.  Prospective audit of the use of fresh-frozen plasma, based on Canadian Medical Association transfusion guidelines. , 2002, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[13]  S. Brett,et al.  Blood component use in critically ill patients , 2002, Anaesthesia.

[14]  N. Fisher,et al.  Central venous cannulation in patients with liver disease and coagulopathy – a prospective audit , 1999, Intensive Care Medicine.

[15]  Jones,et al.  Clinical use of FFP: results of a retrospective process and outcome audit , 1998, Transfusion medicine.

[16]  V. Farewell,et al.  Conditional inference for subject-specific and marginal agreement: Two families of agreement measures† , 1995 .

[17]  P. Gibson,et al.  Appropriateness of transfusions of red cells, platelets and fresh frozen plasma , 1995, The Medical journal of Australia.

[18]  A. E. Horvath,et al.  Practice parameter for the use of fresh-frozen plasma, cryoprecipitate, and platelets. Fresh-Frozen Plasma, Cryoprecipitate, and Platelets Administration Practice Guidelines Development Task Force of the College of American Pathologists. , 1994, JAMA.

[19]  D. Heimbach,et al.  Clotting factor levels and the risk of diffuse microvascular bleeding in the massively transfused patient , 1987, British journal of haematology.

[20]  J. Clarke,et al.  Prothrombin and partial thromboplastin times as preoperative screening tests. , 1982, Archives of surgery.