Clinical audit of fresh frozen plasma usage in a Tertiary Care Hospital of Islamabad, Pakistan

Abstract

Introduction: The supply of blood components in Pakistan far outstrips the demand. In addition, appropriate and rationale use of blood components is not widely practiced. To optimally utilize the limited supply of blood products, it is important to identify and define the gaps in practices and system. The specific aim of the study was to document the practices of the use of fresh frozen plasma (FFP) in a premier tertiary care hospital of Islamabad, Pakistan. Materials and Methods: The study was carried out on 107 randomly selected patients who received FFPs in various clinical units of the Shaheed Zulfiqar Ali Bhutto Medical University Hospital from March to October 2014. Information was retrieved from the transfusion request forms and evaluated according to the American College of Pathologist guidelines for the use of FFP. A questionnaire was also developed for interviewing the senior doctors from each specialty to have their feedback about the transfusion services provided. Nineteen clinicians were randomly selected for this purpose. Results: Requests from 107 patients for 460 FFPs were studied (actual number of FFPs issued was 278). Nearly 68.3% (n = 73) of the patients were males and 31.7% (n = 34) were females. Majority of the units were requested from thalassemia and hemophilia center (40.6%). The patients enrolled in the study had multiple disorders, majority being with coagulation disorders at 40.1% (n = 43). Nearly 98.5% (n = 138) of the request forms were brought to blood bank by the patient attendants. Seventy-three (52%) FFP units were appropriately transfused while 67 (48%) were inappropriately transfused. The most inappropriate use of FFP was seen in Mother and Child Health Centre (MCHC), Oncology, Emergency and Casualty, and the most appropriate use was seen in thalassaemia centre, paediatric units, and medical intensive care unit. Clinician interviews indicate poor knowledge base and inappropriate practices. Conclusion: The study highlighted the inappropriate use of FFPs in a tertiary care hospital and threw light on poor transfusion practices and the lack of implementation of the principles of haemovigilance in the utilization of FFPs. Specific recommendations include, administrative intervention with regular screening of requests by blood bank doctors and senior doctors of the departments using FFP and establishment of guidelines in departments regarding the use of blood components including FFP.