Use Of Fresh Frozen Plasma Research Articles

Predictive haemostatic biomarkers and transfusion efficacy, insights from fresh frozen plasma use in surgical patients, preliminary results

The aim of the study was to examine various haemostasis values to identify the most relevant biological indicators for detecting significant haemorrhage, to determine the effectiveness of fresh frozen plasma (FFP) transfusion. Our findings suggest that a low prothrombin time, elevated Von Willebrand Antigen, increased plasma fibrinogen, and reduced Ca2 + levels are associated with challenges in achieving proper haemostasis. However, measurements of factors II, V, VII, VIII, IX, X, XI, XIII, protein C, and protein S do not appear to be linked to difficulties in achieving adequate haemostasis. Additionally, the administration of FFP appears to impact factors V, VII, X, and II.Trial registration EudraCT number: 2019-002898-64.

Use of Fresh Frozen Plasma in a Dramatic Case of ACE-Inhibitor Associated Angioedema

Angioedema describes a non-dependent, non-pitting and transient edema caused by the accumulation of vasoactive substances in the circulation. These vasoactive substances increase vascular permeability, causing swelling of the deep dermal, submucosal or subcutaneous tissues of the face, lips, neck, extremities or gastrointestinal tract. Urticaria may or may not accompany this condition. Angioedema is generally mediated through two pathways: histamine-mediated and bradykinin-mediated. Histamine-mediated angioedema generally responds to standard therapeutic measures (such as antihistamines, steroids and epinephrine), whereas bradykinin-mediated angioedema can be more difficult to manage in emergency departments (ED). Here, we present a patient who presented to our ED with bradykinin-mediated ACE-I-associated dramatic angioedema clinic, did not respond to standard treatments, rapidly improved with fresh frozen plasma (FFP) administration and was discharged after 6 days of follow-up in the emergency critical intensive care unit.

Effect of Hemodynamic Monitoring Systems on Short-Term Outcomes after Living Donor Liver Transplantation.

Background and Objectives: To evaluate the effects of the pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method hemodynamic monitoring systems on short-term graft and patient outcomes during living donor liver transplantation in adult patients. Materials and Methods: Overall, 163 adult patients who underwent living donor liver transplantation between January 2018 and March 2022 and met the study inclusion criteria were divided into two groups based on the hemodynamic monitoring systems used during surgery: the MostCare Pressure Recording Analytical Method group (n = 73) and the pulse index continuous cardiac output group (n = 90). The groups were compared with respect to preoperative clinicodemographic features (age, sex, body mass index, graft-to-recipient weight ratio, and Model for End-stage Liver Disease score), intraoperative clinical characteristics, and postoperative biochemical parameters (aspartate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, prothrombin time, international normalized ratio, and platelet count). Results: There were no significant between-group differences with respect to recipient age, sex, body mass index, graft-to-recipient weight ratio, Child, Model for End-stage Liver Disease score, ejection fraction, systolic pulmonary artery pressure, surgery time, anhepatic phase, cold ischemia time, warm ischemia time, erythrocyte suspension use, human albumin use, crystalloid use, urine output, hospital stay, and intensive care unit stay. However, there was a significant difference in fresh frozen plasma use (p < 0.001) and platelet use (p = 0.037). Conclusions: The clinical and biochemical outcomes are not significantly different between pulse index continuous cardiac output and MostCare Pressure Recording Analytical Method as hemodynamic monitoring systems in living donor liver transplantation. However, the MostCare Pressure Recording Analytical Method is more economical and minimally invasive.

Fresh frozen plasma transfusion after cardiac surgery.

Fresh frozen plasma (FFP) transfusion in the intensive care unit (ICU) is commonly used to treat coagulopathy and bleeding in cardiac surgery, despite suggestion that it may increase the risk of morbidity and mortality through mechanisms such as fluid overload and infection. We retrospectively studied consecutive adults undergoing cardiac surgery from the Medical Information Mart for Intensive Care III and IV databases. We applied propensity score matching to investigate the independent association of within-ICU FFP transfusion with mortality and other key clinical outcomes. Of our 12,043 adults who met inclusion criteria, 1585 (13.2%) received perioperative FFP with a median of 2.48 units per recipient (interquartile range [IQR]: 2.04, 4.33) at a median time of 1.83h (IQR: 0.75, 3.75) after ICU admission. After propensity matching of 952 FFP recipients to 952 controls, we found no significant association between FFP use and hospital mortality (odds ratio (OR): 1.58; 99% confidence interval (CI): 0.57, 3.71), suspected infection (OR: 0.72; 99% CI: 0.49, 1.08), or acute kidney injury (OR: 1.23; 99% CI: 0.91, 1.67). However, FFP was associated with increased days in hospital (adjusted mean difference (AMD): 1.28; 99% CI: 0.27, 2.41; p = .0050), days in intensive care (AMD: 1.28; 99% CI: 0.27, 2.28; p = .0011), and chest tube output in millilitres up to 8h after transfusion (AMD: 92.98; 99% CI: 52.22, 133.74; p < .0001). After propensity matching, FFP transfusion was not associated with increased hospital mortality, but was associated with increased length of stay and no decrease in bleeding in the early post-transfusion period.

Fresh Frozen Plasma in Orthotopic Liver Transplant: Friend or Foe?

Traditionally, the administration of large volumes of fresh frozen plasma (FFP) was common during liver transplant surgery, with no improvement in the results in terms of bleeding and blood-saving. Moreover, this hydric overload caused by FFP may be harmful, leading to an increase in hospital stays and patient morbidity. The objective is to assess the morbidity associated to the use of FFP in the intraoperative period of patients undergoing orthotopic liver transplantation. The study design is an observational retrospective study, collecting data on the transplanted patients from 2010 to 2020. Acute renal failure was more frequent in the group that received FFP than in the group that did not, with a statistical difference (P=.0017). We did not find any statistical difference between the groups in terms of pulmonary complications and graft-associated thromboembolic events CONCLUSIONS: Transfusion of FFP requires large volumes to achieve a relevant elevation of coagulation factors. This hydric overload could justify the high incidence of renal complications found. Prothrombin complex could be an interesting alternative to FFP. Fibrinogen as a first-line therapy could correct perioperative bleeding and reduce the use of FFP.

Role of prophylactic fresh frozen plasma in critically ill neonate to prevent bleeding in disseminated intravascular coagulation: a randomized controlled trial

Background: Disseminated intravascular coagulation (DIC) has a high prevalence in critically ill neonates. In suspicion of DIC based on abnormal coagulation parameter is a common trigger to transfuse fresh frozen plasma (FFP), even in absence of bleeding. In past years, use of FFP has increased and has expanded to include prophylactic use in neonates especially in neonatal intensive care units (NICUs) as it contains several coagulation factors. Several studies suggest that, prophylactic use of FFP has no role to prevent bleeding in disseminated intravascular coagulation (DIC), but carries increase risk of transfusion related mortality and morbidity. Objective: To assess the effectiveness of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC. Methods: This randomized, open-label, blinded end-point study was conducted in Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital from July, 2019 to June, 2021. Term, critically ill neonates who had underlying disease, suspected to develop DIC were conveniently selected. Later, they were randomly allocated using software in intervention group, who received 10 ml/kg of FFP along with standard management and control group, who received only standard management. Coagulation parameters were checked before and 24 hour after intervention in both groups. Outcome was occurrence of bleeding as a indicator of DIC. Results: The mean age was 8.55 ± 3.5 days in intervention and 8.92 ± 6.1 days in control group. Male patients were predominant. There was no significant difference in baseline characteristics between two groups. The difference of mean ± SD of coagulation parameters between two groups were nonsignificant before intervention. Even after FFP transfusion, DIC developed among 40.1% neonates in intervention and without FFP transfusion among 48.9% neonates in control group without any significant difference (P-value &gt;0.05). Conclusion: Study result found no role of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC. Bangladesh Medical Res Counc Bull 2022; 48: 146-153

Emergency administration of fibrinogen concentrate for haemorrhage: systematic review and meta-analysis

IntroductionThe occurrence of massive haemorrhages in various emergency situations increases the need for blood transfusions and increases the risk of mortality. Fibrinogen concentrate (FC) use may increase plasma fibrinogen levels more rapidly than fresh-frozen product or cryoprecipitate use. Previous several systematic reviews and meta-analyses have not effectively demonstrated FC efficacy in significantly improving the risk of mortality and reducing transfusion requirements. In this study, we investigated the use of FC for haemorrhages in emergency situations.Methods and analysisIn this systematic review and meta-analysis, we included controlled trials, but excluded randomized controlled trials (RCTs) in elective surgeries. The study population consisted of patients with haemorrhages in emergency situations, and the intervention was emergency supplementation of FC. The control group was administered with ordinal transfusion or placebo. The primary and secondary outcomes were in-hospital mortality and the amount of transfusion and thrombotic events, respectively. The electronic databases searched included MEDLINE (PubMed), Web of Science, and the Cochrane Central Register of Controlled Trials.ResultsNine RCTs in the qualitative synthesis with a total of 701 patients were included. Results showed a slight increase in in-hospital mortality with FC treatment (RR 1.24, 95% CI 0.64–2.39, p = 0.52) with very low certainty of the evidence. There was no reduction in the use of red blood cells (RBC) transfusion in the first 24 h after admission with FC treatment (mean difference [MD] 0.0 Unit in the FC group, 95% CI − 0.99–0.98, p = 0.99) with very low certainty of the evidence. However, the use of fresh-frozen plasma (FFP) transfusion significantly increased in the first 24 h after admission with FC treatment (MD 2.61 Unit higher in the FC group, 95% CI 0.07–5.16, p = 0.04). The occurrence of thrombotic events did not significantly differ with FC treatment.ConclusionsThe present study indicates that the use of FC may result in a slight increase in in-hospital mortality. While FC did not appear to reduce the use of RBC transfusion, it likely increased the use of FFP transfusion and may result in a large increase in platelet concentrate transfusion. However, the results should be interpreted cautiously due to the unbalanced severity in the patient population, high heterogeneity, and risk of bias.

Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in treatment of peritoneal metastasis.

It was aimed to define the oncologic concept of "extremeness" in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) to determine morbidity-mortality results and final oncologic outcomes. Prospectively recorded data of 666 patients with peritoneal metastases who had undergone CRS/HIPEC between 2007 and 2020 were analyzed. Patients were divided into two groups as extreme (n= 371) and non-extreme (n= 295). Extreme CRS was defined as resection of ≥5 major organs or creation of ≥2 bowel anastomoses or peritoneal carcinomatosis index (PCI)≥ 15 or re-cytoreductive surgery. More CC-1 or CC-2 cytoreduction (p <.001), increased mortality and morbidity (p <.001), prolonged operative time (p <.001), increased intraoperative erythrocyte suspension (p <.001), albumin (p <.001), fresh frozen plasma (FFP) (p <.001), and post-operative erythrocyte suspension (p <.001) usage were found in the extreme CRS/HIPEC group. Operative time, CC-1 or CC-2 cytoreduction, presence of ostomy, development of infection, and use of intra-operative albumin and FFP were found to be independent prognostic factors in Cox regression analysis. Three and five-year survival rates were significantly lower in the extreme CRS/HIPEC group (p <.001). High-volume peritoneal metastatic disease can be completely resected with extreme cytoreduction in carefully selected patients responsive to chemotherapy. Since the significant morbi-mortality related to the treatment of peritoneal metastasis is a real concern, it should be considered in experienced complex cancer centers that provides relatively better oncological outcomes compared to conventional treatments.

Defining Current Patterns of Blood Product Use during Intensive Induction Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia Patients

Introduction Blood product transfusion continues to retain a critical role in the supportive care of patients with acute myeloid leukemia (AML) particularly during the initial phase of intensive induction chemotherapy. Whereas previous studies have shown increased transfusion dependency to portend inferior outcome, clinical and disease features predictive of an increased transfusion burden and the overall prognostic impact of transfusion support in this setting have not been determined as of yet. Herein, we evaluated the various blood product components administered during induction aiming to delineate current transfusion practices in AML patients. Methods We reviewed the medical records of 180 consecutive adult patients with newly diagnosed AML, who were treated with intensive chemotherapy from December 2014 through January 2022 at the Sheba Medical Center. Clinical data extraction and exploration were done with the MDClone big data platform. All patients assessed in the study received standard anthracycline and cytarabine-based intensive induction chemotherapy or CPX-351. Patients received irradiated and leukodepleted blood products. Alloimmunization was defined according to the National Heart, Lung, and Blood Institute working group criteria. Results The analysis comprised 180 patients with a median age of 57 years (range 19-77) with 80% designated as de novo AML and the remainder as secondary AML. Fifty-four patients (31%) were FLT3-ITD mutated and 73 patients (42%) harbored NPM1. Favorable risk and intermediate risk ELN 2017 patients accounted for 43% and 34% of patients, respectively. The median number of red blood cell (RBC) and platelet units given during induction were 9 units and 7, respectively. Seventeen patients (9%) received cryoprecipitate and fresh frozen plasma (FFP) was given to 12 patients (7%). Lower initial hemoglobin and platelet levels were predictive of increased use of RBC (p<0.0001) and platelet transfusions (p<0.0001). Use of FFP was significantly associated with induction related mortality (42% versus 5%; p<0.0001) and with FLT3-ITD status (72% versus 28%; p=0.004). Transfusion associated alloimmunization was seen in 7 patients (4%) with patients with lower mean initial platelet counts being more likely to experience alloimmunization (38 X 109/l versus 83 X 109/l; p=0.01). Alloimmunized patients had significantly higher RBC transfusion (14 units versus 9.5 units; p=0.012) and prestorage leukodepleted filtered RBC (6.1 units versus 1.6 units; p<0.0001) requirements during induction compared with non-alloimmunized patients. Blood group AB experienced improved mean overall survival compared to blood group O patients (4.1 years versus 2.8 years; p=0.025). In multivariate analysis, increased number of FFP [hazard ratio (HR), 4.23; 95% confidence interval (CI), 2.1-8.6; p<0.001) and RBC units (HR, 1.8; 95% CI, 1.2-2.8; p=0.008) given was associated with inferior survival. Conclusion In this analysis we comprehensively mapped the transfusion trajectory of AML patients during induction therapy and identified clinically meaningful associations impacting the need for the various blood components as well as overall survival. Transfusion needs during induction crucially impact the clinical trajectory of AML patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Long-Term Follow-up of Patients with Congenital Thrombotic Thrombocytopenia Purpura Receiving Plasma-Derived Factor VIII Containing (Koate®)

Background: Congenital thrombotic thrombocytopenia purpura (cTTP) is an ultra-rare disorder resulting from an inherited deficiency of ADAMTS13, a von Willebrand factor (VWF)-cleaving metalloprotease. Clinically, cTTP is characterized by recurring, and potentially life-threatening, episodes of VWF-platelet aggregation and microvascular thrombosis. Treatment has traditionally been replacement of ADAMTS13 using fresh frozen plasma (FFP) or solvent detergent treated plasma, options which are limited by risks of severe allergic reactions, viral exposure, and volume overload. The marketed plasma-derived factor VIII/VWF Koate® (hereafter, FVIII/VWFKoate) has been shown to have the highest concentration of ADAMTS13 among tested plasma-derived concentrates [Peyvandi F, et al. Am J Hematol. 2013;88:895-898] and can be administered by the patient or a caregiver in the patient's home. Based on a prior case series that reported safe and effective use of FVIII/VWFKoate in 8 patients with cTTP [Aledort LM, et al. J Pediatr Hematol Oncol 2017;39:524-527], we conducted a retrospective study to gather additional data regarding the use of FVIII/VWFKoate for this disease. Methods: This was a multi-center (United States, n=8 sites; Canada, n=1 site), retrospective, non-interventional chart review of patients who had received at least one dose of FVIII/VWFKoate for the management of cTTP between 8/1/2014 and 1/31/21 (through 12/31/21 at one center). Data collected included patient demographics, medical and family history relevant to cTTP, past use and tolerability of FFP, and details regarding FVIII/VWFKoate therapy, including dose, duration of therapy, TTP episodes, clinical and laboratory outcomes, adverse events (AEs), and reported difficulty with FVIII/VWFKoate administration. Results: The cohort included 11 patients (7 males, 4 females) with cTTP, ranging in age (at the time of data collection) from 2-28 years (Table 1). Age at diagnosis of cTTP ranged from 0 months to 15 years. Eight patients had at least one immediate family member with cTTP. Eight patients had been previously treated with FFP and 5 were noted to have experienced AEs including allergic reactions/rashes. The average duration of therapy with FVIII/VWFKoate was 4.8 years (range, 0.5-6.5 years). Individual FVIII/VWFKoate doses ranged from 1000-3700 IU per dose. Nine patients used FVIII/VWFKoate regularly as prophylaxis; dosing frequencies at the time of data collection included weekly (n=5), twice weekly (n=2), 3 times/week (n=1), and every 2 weeks (n=1). Two patients used FVIII/VWFKoate only as needed. Doses were administered by the patient/caregiver (n=9) or by a nurse (n=2). Among the 9 patients using FVIII/VWFKoate on an ongoing basis as prophylaxis, the normalized annual rate of breakthrough TTP episodes ranged from 0.2 to 1.1 episodes/year. There were no AEs attributed to FVIII/VWFKoate. At the time of cTTP diagnosis, 4 patients had microangiopathic hemolytic anemia, and 3 of the 4 did not have persistent anemia following treatment with FVIII/VWFKoate; 1 additional patient had persistent anemia considered unrelated to cTTP. Among 8 patients who used FVIII/VWFKoate as prophylaxis and who had baseline data regarding presence/absence of thrombocytopenia, all 8 had thrombocytopenia prior to FVIII/VWFKoate and 7 of the 8 (87.5%) did not have thrombocytopenia after using FVIII/VWFKoate (95% confidence interval, 46.7% to 99.3%). The 1 patient who had residual thrombocytopenia after using FVIII/VWFKoate had no recorded TTP episodes while using FVIII/VWFKoate. Renal impairment was noted in 1 patient at the time of diagnosis and 1 (different) patient following FVIII/VWFKoate treatment. None of the patients were noted to have evidence of residual CNS impairment at the time of diagnosis or following FVIII/VWFKoate treatment. Conclusions: These data, reflecting treatment periods averaging almost 5 years, suggest that FVIII/VWFKoate appears to be a safe and effective source of the missing ADAMTS13 enzyme in patients with cTTP, producing a marked reduction in prevalence of thrombocytopenia, low frequency of TTP episodes, and with the added benefit of self- or caregiver-administration. Regimens of FVIII/VWFKoate varied greatly in this real-world study, and additional experience is needed to optimize dosing recommendations for this rare disease. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Thromboelastography-Guided Therapy Enhances Patient Blood Management in Cirrhotic Patients: A Meta-analysis Based on Randomized Controlled Trials.

Patients with cirrhosis often have abnormal hemostasis, with increased risk of hemorrhage and thrombosis. Thromboelastography provides a rapid assessment of the coagulation status and can guide product transfusions in adult patients with cirrhosis. This study aimed to determine whether the use of thromboelastography in adult patients with cirrhosis decreases blood product use and impacts adverse events or mortality compared with standard practice. A registered (PROSPERO CRD42020192458) systematic review and meta-analysis was conducted for randomized controlled trials (RCTs) comparing thromboelastography-guided hemostatic management versus standard practice (control). Co-primary outcomes were the number of transfused platelet units and fresh frozen plasma (FFP) units. Secondary outcomes were mortality, adverse events, utilization of individual blood products, blood loss or excessive bleeding events, hospital/intensive care unit stay, and liver transplant/intervention outcomes. The search identified 260 articles, with five RCTs included in the meta-analysis. Platelet use was five times lower with thromboelastography versus the control, with a relative risk of 0.17 (95% confidence interval [CI]: [0.03-0.90]; p = 0.04), but FFP use did not differ significantly. Thromboelastography was associated with less blood product (p < 0.001), FFP + platelets (p < 0.001), and cryoprecipitate (p < 0.001) use. No differences were reported in bleeding rates or longer term mortality between groups, with the thromboelastography group having lower mortality at 7 days versus the control (relative risk [95% CI] = 0.52 [0.30-0.91]; p = 0.02). Thromboelastography-guided therapy in patients with cirrhosis enhances patient blood management by reducing use of blood products without increasing complications.

Use of Fresh-frozen Plasma in Newborn Infants.

Nearly 10% of premature and critically ill infants receive fresh-frozen plasma (FFP) transfusions to reduce their high risk of bleeding. The authors have only limited data to identify relevant clinical predictors of bleeding and to evaluate the efficacy of FFP administration. There is still no consensus on the optimal use of FFP in infants who have abnormal coagulation parameters but are not having active bleeding. The aims of this review are to present current evidence derived from clinical studies focused on the use of FFP in neonatology and then use these data to propose best practice recommendations for the safety of neonates receiving FFP.

Thromboelastography-Guided Therapy Enhances Patient Blood Management in Cirrhotic Patients: A Meta-analysis Based on Randomized Controlled Trials

Patients with cirrhosis often have abnormal hemostasis, with increased risk of hemorrhage and thrombosis. Thromboelastography provides a rapid assessment of the coagulation status and can guide product transfusions in adult patients with cirrhosis. This study aimed to determine whether the use of thromboelastography in adult patients with cirrhosis decreases blood product use and impacts adverse events or mortality compared with standard practice. A registered (PROSPERO CRD42020192458) systematic review and meta-analysis was conducted for randomized controlled trials (RCTs) comparing thromboelastography-guided hemostatic management versus standard practice (control). Co-primary outcomes were the number of transfused platelet units and fresh frozen plasma (FFP) units. Secondary outcomes were mortality, adverse events, utilization of individual blood products, blood loss or excessive bleeding events, hospital/intensive care unit stay, and liver transplant/intervention outcomes. The search identified 260 articles, with five RCTs included in the meta-analysis. Platelet use was five times lower with thromboelastography versus the control, with a relative risk of 0.17 (95% confidence interval [CI]: [0.03-0.90]; p = 0.04), but FFP use did not differ significantly. Thromboelastography was associated with less blood product (p < 0.001), FFP + platelets (p < 0.001), and cryoprecipitate (p < 0.001) use. No differences were reported in bleeding rates or longer term mortality between groups, with the thromboelastography group having lower mortality at 7 days versus the control (relative risk [95% CI] = 0.52 [0.30-0.91]; p = 0.02). Thromboelastography-guided therapy in patients with cirrhosis enhances patient blood management by reducing use of blood products without increasing complications.

Thromboelastography-Guided Therapy Enhances Patient Blood Management in Cirrhotic Patients: A Meta-analysis Based on Randomized Controlled Trials.

Patients with cirrhosis often have abnormal hemostasis, with increased risk of hemorrhage and thrombosis. Thromboelastography provides a rapid assessment of the coagulation status and can guide product transfusions in adult patients with cirrhosis. This study aimed to determine whether the use of thromboelastography in adult patients with cirrhosis decreases blood product use and impacts adverse events or mortality compared with standard practice. A registered (PROSPERO CRD42020192458) systematic review and meta-analysis was conducted for randomized controlled trials (RCTs) comparing thromboelastography-guided hemostatic management versus standard practice (control). Co-primary outcomes were the number of transfused platelet units and fresh frozen plasma (FFP) units. Secondary outcomes were mortality, adverse events, utilization of individual blood products, blood loss or excessive bleeding events, hospital/intensive care unit stay, and liver transplant/intervention outcomes. The search identified 260 articles, with five RCTs included in the meta-analysis. Platelet use was five times lower with thromboelastography versus the control, with a relative risk of 0.17 (95% confidence interval [CI]: [0.03-0.90]; p = 0.04), but FFP use did not differ significantly. Thromboelastography was associated with less blood product (p < 0.001), FFP + platelets (p < 0.001), and cryoprecipitate (p < 0.001) use. No differences were reported in bleeding rates or longer term mortality between groups, with the thromboelastography group having lower mortality at 7 days versus the control (relative risk [95% CI] = 0.52 [0.30-0.91]; p = 0.02). Thromboelastography-guided therapy in patients with cirrhosis enhances patient blood management by reducing use of blood products without increasing complications.

Plasma Transfusion in Septic Shock-A Secondary Analysis of a Retrospective Single-Center Cohort.

In sepsis, both beneficial and detrimental effects of fresh frozen plasma (FFP) transfusion have been reported. The aim of this study was to analyze the indication for and effect of FFP transfusion in patients with septic shock. We performed a secondary analysis of a retrospective single-center cohort of all patients treated for septic shock at the interdisciplinary surgical intensive care unit (ICU) of the Heidelberg University Hospital. Septic shock was defined according to sepsis-3 criteria. To assess the effects of FFP administration in the early phase of septic shock, we compared patients with and without FFP transfusion during the first 48 h of septic shock. Patients who died during the first 48 h of septic shock were excluded from the analysis. Primary endpoints were 30- and 90-day mortality. A total of 261 patients were identified, of which 100 (38.3%) received FFP transfusion within the first 48 h after septic shock onset. The unmatched analysis showed a trend toward higher 30- and 90-d mortality in the FFP group (30 d: +7% p = 0.261; 90 d: +11.9% p = 0.061). In the propensity-matched analysis, 30- and 90-day mortality were similar between groups. Plasma administration did not influence fluid or vasopressor need, lactate levels, ICU stay, or days on a ventilator. We found no significant harm or associated benefit of FFP use in the early phase of septic shock. Finally, plasma should only be used in patients with a strong indication according to current recommendations, as a conclusive evaluation of the risk-benefit ratio for plasma transfusion in septic shock cannot be made based on the current data.

Fresh frozen plasma and cryoprecipitate: Can we safely reduce their use in the NICU?

To study patterns of use of Fresh Frozen Plasma (FFP) and Cryoprecipitate (CRYO) in a level 4 NICU and assess what proportions were not supported by literature. single centered retrospective observational. Charts of neonates admitted between 1/1/2010 to 12/31/2017 to CT Children's level 4 NICU were reviewed. Transfusions were assigned as "supported" or "non-supported" based on available evidence. Groups were compared using T-tests and chi-squared analyses. of 4110 total admissions, 197 (4.8%) received a total of 461 transfusions (374 FFP, 87 CRYO). Only 59% of FFP and 60% CRYO were supported by literature. Within the "non-supported" group the largest category was neonates transfused prophylactically. A large proportion of transfusions administered to neonates was not evidence-based, suggesting there are opportunities for improvement in use of these products.

Whole Blood in Trauma Resuscitation: What Is the Real Cost?

Whole blood (WB) has gained popularity in trauma resuscitation within the past 5y. Previously, its civilian use was limited due to advances in blood component fractionation and fears of hemolysis and infectious disease transmission. Although there are studies and review articles on the efficacy of WB, the analysis of cost pertaining to the use of WB is limited. We performed a retrospective 1:1 propensity-matched analysis of 280 subjects comparing trauma patients receiving resuscitation with blood component therapy (BCT) to those receiving WB plus BCT between January 2014 and July 2019. WB was used for patients who arrived in hemorrhagic shock with systolic blood pressure <90mmHg due to either penetrating or blunt trauma. Endpoints included the number of units of WB, packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate each patient received. Institution costs for each component were compared in the form of price ratios. Comparisons were made using Wilcoxon rank-sum tests with a P value of ≤0.05 considered statistically significant. The use of WB was associated with a statistically significant decrease in the number of PRBCs used when compared to BCT. This holds true with the cost of PRBCs being lower among the WB group when the price is controlled. Similarly, a trend was found where FFP, platelets, and cryoprecipitate use and cost showed an absolute decrease between WB and BCT groups. The use of WB is associated with decreased total cost as well (P=0.1660), although not statistically significant. Adding WB to BCT for trauma resuscitation was associated with lower red blood cell use and cost. A similar trend was found that absolute total cost and absolute cost of FFP, platelets, and cryoprecipitate use was lower when WB was added. WB wastage was minimized due to repurposing WB into PRBCs when WB lifespan ended.

Analysis of fresh frozen plasma utilization indications in children: An audit of a tertiary care hospital in Turkey

BackgroundAlthough indications of fresh frozen plasma (FFP) usage are limited to certain circumstances in children, there is an increasing trend towards inappropriate usage are reported in clinical practice. The aim of this study was to evaluate the appropriateness of pediatric FFP utilization in our tertiary care hospital. MethodsThis prospective observational study was conducted at a tertiary care academic pediatric hospital. All FFP orders were evaluated for appropriateness over a 4-monts period by 2 hematologists. Data collected include demographic information, diagnosis, FFP transfusion indication, pre-transfusion coagulation tests, surgical procedure or bleeding status, and transfusion reactions. ResultsThree hundred twenty-four patients (57 % males, 43 % females) were transfused in 987 episodes. The mean age of the patients was 5.4±5.7 years. The majority of the patients (33 %) were under 1 y of age and the products were primarily utilized by pediatric and cardiovascular intensive care units. Pre-transfusion coagulation testing was only available in 674 (68 %) of the transfusion episodes. The rate of appropriate FFP transfusion episodes was 59 % (587/987). Inappropriate usage was mostly related to sepsis and minor coagulation abnormalities without bleeding. The higher rates of inappropriate transfusion orders were observed in pediatric and neonatal intensive care units, and hematology/oncology departments. ConclusionsInappropriate use of FFP in children remains a significant challenge. The regular audit and sustainable education programs targeting the efficient use of FFP for health professionals at the national level can improve transfusion practices.

Implementation of Viscoelastic Hemostatic Assay-guided Therapy to Evaluate and Manage Trauma-related Bleeding: A Pilot Study from a Level 1 Trauma Center in Bangkok, Thailand

Objective: To evaluate the effectiveness of viscoelastic hemostatic assay (VHA)-guided therapy for assessing and managing trauma-related bleeding using a multidisciplinary team approach at a level 1 trauma center.Materials and Methods: This retrospective pilot study included trauma-related hemorrhagic patients who underwent rotational thromboelastometry (ROTEM) during September 2019-May 2020. ROTEM trace results were compared with those of conventional coagulation tests (CCT).Results: Thirteen patients (median age: 29.1 years; male: 76.92%) were included. The median (range) days of ventilator support, ICU length of stay, and hospital length of stay was 4 [0-65], 5 [1-65], and 6 [1-83], respectively. ROTEM-guided therapy was applied 26 times, and was repeated in 7 cases. Of those, four cases were repeated to correct coagulopathy. The median time-to-confirmed hemostasis for ROTEM was substantially shorter than for CCT (92 minutes [70-110] vs. 287 minutes [204-354], respectively). The coagulation results from 26 ROTEM tests were also compared between those requiring and not requiring a massive transfusion protocol (MTP). MTP with ROTEM-guided therapy was activated in 6/13 cases. Following the resuscitation endpoints in traumatic shock, four of those had their median serum lactate levels decreased from 10.9 d/L (2.1-16.8) to 3.9 d/L (1.7-17.7). ROTEM traces detected cases with low fibrinogen that only required cryoprecipitate transfusion, and red blood cell and fresh frozen plasma use was less in ROTEM than in conventional MTP.Conclusion: VHA-guided therapy was shown to effectively facilitate goal-directed hemostatic resuscitation and efficient blood product use during resuscitation, definitive treatment, and postoperative intensive care.

Outcomes following formation of a dedicated pediatric liver transplant anesthesia team.

Given the complex nature of liver transplant surgery, adult centers typically use a dedicated liver transplant anesthesia team, which has improved patient outcomes. Our goal was to determine whether a dedicated pediatric liver transplant anesthesia team was associated with improved patient outcomes. This retrospective cohort study analyzed patients who underwent liver transplantation from April 2013 to September 2020 at St. Louis Children's Hospital. The general group (April 2013-December 2016) was compared with the liver group (January 2017-September 2020). Outcomes measured included cases per anesthesiologist, early extubation, ventilator days, fluid and blood administration, postoperative events, and intensive care unit and hospital length of stay (LOS). Patients in both groups had similar demographics. The average number of cases/anesthesiologist/year was 2.9 times higher in the liver group (mean (SD) general 0.7 (0.5), liver 2.0 (0.6), and difference in mean [95% CI] 1.3 [0.8, 1.8]). The rate of extubation in the operating room was higher for patients in the liver group (general 56%, liver 80%, and difference in proportion [95% CI] 24.7 [7.0, 42.4]), while the number of ventilator days was lower (mean (SD) general 2.1 (4.4), liver 1.1 (3.6), and difference in proportion [95%CI] -0.9 [-2.6, 0.7]). Colloid administration was higher in the liver group (mean (SD) general 23.9 (14.5) ml/kg, liver 48.4 (37.7) ml/kg, and difference in mean [95% CI] 24.6 [12.7, 36.4]), while fresh frozen plasma administration was lower in the liver group (mean (SD) general 15.3 (23.9) ml/kg, liver 6.2 (14) ml/kg, and difference in mean [95% CI] -9.0 [-16.8, -1.3]). There were no significant differences between the groups in postoperative events including blood product transfusions, vasopressor use, and thromboses, or in the intensive care unit and hospital LOS. The liver group was associated with increased early extubations, decreased ventilator days, and decreased fresh frozen plasma use.