Inappropriate Use Of Fresh Frozen Plasma Research Articles

Early Fresh Frozen Plasma Transfusion: Is It Associated With Improved Outcomes of Patients With Sepsis?

Background: So far, no study has investigated the effects of plasma transfusion in the patients with sepsis, especially in the terms of prognosis. Therefore, we aimed to explore the association of early fresh frozen plasma (FFP) transfusion with the outcomes of patients with sepsis.Methods: We performed a cohort study using data extracted from the Medical Information Mart for Intensive Care III database (v1.4). External validation was obtained from the First Affiliated Hospital of Wenzhou Medical University, China. We adopted the Sepsis-3 criteria to extract the patients with sepsis and septic shock. The occurrence of transfusion during the first 3-days of intensive care unit (ICU) stay was regarded as early FFP transfusion. The primary outcome was 28-day mortality. We assessed the association of early FFP transfusion with the patient outcomes using a Cox regression analysis. Furthermore, we performed the sensitivity analysis, subset analysis, and external validation to verify the true strength of the results.Results: After adjusting for the covariates in the three models, respectively, the significantly higher risk of death in the FFP transfusion group at 28-days [e.g., Model 2: hazard ratio (HR) = 1.361, P = 0.018, 95% CI = 1.054–1.756] and 90-days (e.g., Model 2: HR = 1.368, P = 0.005, 95% CI = 1.099–1.704) remained distinct. Contrarily, the mortality increased significantly with the increase of FFP transfusion volume. The outcomes of the patients with sepsis with hypocoagulable state after early FFP transfusion were not significantly improved. Similar results can also be found in the subset analysis of the septic shock cohort. The results of external validation exhibited good consistency.Conclusions: Our study provides a new understanding of the rationale and effectiveness of FFP transfusion for the patients with sepsis. After recognizing the evidence of risk-benefit and cost-benefit, it is important to reduce the inappropriate use of FFP and avoid unnecessary adverse transfusion reactions.

Evaluation of using fresh frozen plasma for patients with cirrhosis at a tertiary healthcare center in Turkey: Strict transfusion policies are essential

AimManagement of blood transfusions is a critical issue, especially in cirrhotic patients, because of the absence of national policies in many countries. Fresh frozen plasma (FFP) is a common blood component misused excessively in various clinical situations and cirrhosis patients without any scientific rationale. We evaluated the FFP transfusions in patients with cirrhosis at our tertiary care hospital. Material and MethodThe cases with cirrhosis diagnosed between 2014 and 2020 were selected using the hospital database. The appropriateness of FFP transfusion was determined based on the Practice Guidance by the American Association for the Study of Liver Diseases and Italian guidelines. ResultTwo hundred and six liver cirrhosis patients were identified who received FFP transfusion. The median age was 63 (22–94). Of the 206 patients, 79 (38.3 %) were female, and 127 (61.7 %) were men. The most common causes of liver cirrhosis were alcohol (27.7 %). 45.6 % of the patients were in Child-Pugh Class C. We found 62.1 % of FFP replacements were inappropriately used. Most inappropriate use of FFP (22.8 %, n = 47) occurred to correct prolonged INR in the absence of bleeding. ConclusionTo avoid inappropriate usage of FFP, regular utilization reviews and formal education programs can be helpful. Our clinic has planned to arrange educational programs for physicians to use blood products appropriately and minimize transfusion-related side effects.

FRESH FROZEN PLASMA

Introduction: As the use of Fresh Frozen Plasma (FFP) is having establishedcomplications including Allergic reactions, infectious complications, hemolysis, fluid overload, transfusion related acute lung injury (TRALI) and immune suppression, therefore it mustbe used cautiously. Objectives: To evaluate the inappropriate use of FFPs, to carry out anaudit of appropriateness of FFP transfusion with reference to international guidelines and setfoundations for blood bank and transfusion protocols. Study Design: Cross sectional study.Setting: Khyber Teaching Hospital Peshawar. Period: 6 months, 1st January 2016 to 30th June2016. Methods: During which FFP transfusion requests made to the blood bank by various unitsof the hospital were studied including general surgery, surgical ICU, general medicine, medicalICU, gynecology and obstetrics. Seventy Six requests were received that were judged using6 variables: indication for FFP use, sampling errors, laboratory analysis errors, interpretationerrors, dosage of FFP (number of units being transfused) and timing of FFP transfusion. Scoreof “1” was given for each correct variable. After matching data to the international protocols, ascore of 4-5 was taken as appropriate and <3 was classified as inappropriate. Results: TwentySeven (35.5%) FFP transfusions were done with a score of 4-5 and were considered appropriatewhile 49(64.5%) FFP transfusions were given a score of 3 or less and were consideredinappropriate. Conclusions: Almost two third of FFP were used inappropriately in our hospital,the commonest indication being acute Disseminated Intravascular Coagulation (DIC) andmostly requested from surgical units. Maximum cases of inappropriate transfusions were dueto wrong sampling techniques and wrong dosage calculations. Most inappropriate transfusionswere done in MICU. It is recommended that annual clinical audit of all blood products usageshould be conducted. Local guidelines for physicians and training programs for nurses andparamedics regarding proper use of blood products should be established.

INAPPROPRIATE USE OF FRESH FROZEN PLASMA AN AUDIT OF A TERTIARY CARE HOSPITAL.

Introduction: As the use of Fresh Frozen Plasma (FFP) is having establishedcomplications including Allergic reactions, infectious complications, hemolysis, fluid overload, transfusion related acute lung injury (TRALI) and immune suppression, therefore it mustbe used cautiously. Objectives: To evaluate the inappropriate use of FFPs, to carry out anaudit of appropriateness of FFP transfusion with reference to international guidelines and setfoundations for blood bank and transfusion protocols. Study Design: Cross sectional study.Setting: Khyber Teaching Hospital Peshawar. Period: 6 months, 1st January 2016 to 30th June2016. Methods: During which FFP transfusion requests made to the blood bank by various unitsof the hospital were studied including general surgery, surgical ICU, general medicine, medicalICU, gynecology and obstetrics. Seventy Six requests were received that were judged using6 variables: indication for FFP use, sampling errors, laboratory analysis errors, interpretationerrors, dosage of FFP (number of units being transfused) and timing of FFP transfusion. Scoreof “1” was given for each correct variable. After matching data to the international protocols, ascore of 4-5 was taken as appropriate and <3 was classified as inappropriate. Results: TwentySeven (35.5%) FFP transfusions were done with a score of 4-5 and were considered appropriatewhile 49(64.5%) FFP transfusions were given a score of 3 or less and were consideredinappropriate. Conclusions: Almost two third of FFP were used inappropriately in our hospital,the commonest indication being acute Disseminated Intravascular Coagulation (DIC) andmostly requested from surgical units. Maximum cases of inappropriate transfusions were dueto wrong sampling techniques and wrong dosage calculations. Most inappropriate transfusionswere done in MICU. It is recommended that annual clinical audit of all blood products usageshould be conducted. Local guidelines for physicians and training programs for nurses andparamedics regarding proper use of blood products should be established.

Long-term audit of the use of fresh frozen plasma in a university hospital.

ObjectivesThere is universal concern about the inappropriate use of fresh frozen plasma (FFP). This study aimed to determine the extent of the inappropriate use of FFP at a university hospital in KSA.MethodsMedical records on the annual use of FFP were analysed from 1986 to 2007. Then, the results of the coagulation screening tests were extracted from the medical records of 531 consecutive patients in various departments of the hospital.ResultsAs many as 68,480 FFP units were used during the 22 year study period. Consumption increased and then plateaued in 1995, but dropped dramatically by 30.9% and reached its lowest level in 2000. There was also a concomitant and overlapping drop in both FFP usage and the hospital mortality rate per patient admission. One-thousand-six-hundred-twenty FFP units were issued for 531 patients. Coagulation testing, before and after infusion, was adopted in almost all patients in the Department of Obstetrics and Gynaecology, in 90% of patients in the Department of Surgery and in approximately 70% of patients in other departments.ConclusionsSignificant inappropriate use of FFP at our institute has been made evident by examining the remarkable drop in use following the universal “HIV scare” of the early 1990s. The resulting drop in the hospital mortality rate, accompanying the simultaneous drop in FFP use, reflects the benefits of resorting to the use of less blood therapy. Coagulation testing was used to a satisfactory extent. Transfusion audits and educational programs could result a better use of FFP.

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

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.

The influence of cardiopulmonary bypass priming without FFP on postoperative coagulation and recovery in pediatric patients with cyanotic congenital heart disease.

Transfusion guidelines have been produced for the evidence-based use of fresh frozen plasma (FFP). However, the inappropriate use of FFP is still a worldwide problem, especially in the prophylactic settings. In the present study, 100 cyanotic pediatric patients (age 6months to 3years) undergoing cardiac surgery with cardiopulmonary bypass (CPB) were randomized to receive either 10-20ml/kg FFP (FFP group, n = 50) or 10-20ml/kg 4% succinylated gelatin (Gelofusine, GEL group, n = 50) in the priming solution. Rapid thromboelastography (r-TEG) was measured before skin incision and 15min after heparin neutralization. Postoperative renal and hepatic function, mediastinal chest tube drainage, transfusion requirements, and recovery time were observed. The relationships between hematologic and demographic data and postoperative bleeding volume were also analyzed. The results showed that there were significantly elevated levels of fibrinogen (r-TEG parameters: fibrinogen contribution to maximal amplitude (MAf) and fibrinogen level (FLEV)) in the FFP group compared to the GEL group. The postoperative blood loss, total transfusion requirements, and recovery time were not significantly different between the two groups, indicating that there were no obvious clinical benefits of using FFP in the priming. The maximal amplitude (MA) of r-TEG measured after heparin neutralization was correlated with the 6-h postoperative bleeding volume. In addition, preoperative fibrinogen level rather than FFP priming was an independent predictor of postoperative blood loss. Prophylactic use of FFP in the priming solution does not have obvious clinical benefits in cyanotic congenital heart disease (CCHD) patients. Gelofusine, an artificial colloid, is a safe and effective substitute of FFP in the priming solution. Furthermore, r-TEG can be used as a "real-time" assessment tool to evaluate postoperative bleeding and guide transfusion after cardiac surgery in pediatric patients.

Appropriate And Inappropriate Fresh Frozen Plasma (Ffp) Use In Coagulation Disorders

AIMS:The aim of this study was to evaluate the usage of fresh frozen plasma (FFP) according to indications and to reduce inappropriate usage. Method: A two year retrospective study was conducted in Dr.S.C.G.M.C.and hospital blood bank . Based on the guidelines published by college of American pathologist,national health and medical research council and Australian society for blood transfusion FFP usage were categorized into appropriate and inappropriate.Pre and post transfusion INR/PT were recorded and the effect of FFP were studied in patients who received FFP Results:During two year study 1079 unit of FFP were used for 267 patients.out of 267 patients only 125(46.81%) request were appropriate and 142(53.19%) were inappropriate requests. Pregnant female with active labour suffering from severe anaemia with shock was the commonest reason for inappropriate FFP use.Out of 125 appropriate request 100 patients were compared by evaluating Pre and post transfusion PT/INR by using fully automated coagulometer. Conclusion: Inappropriate use of FFP not only increase the treatment costs , but also causes loss of productive power and exposes the patient to the unnecessary side effects of transfusion.inappropriate FFP transfusion should be prevented by means of educaton and awareness programme by establishing the hospital transfusion guidelines

Fresh Frozen Plasma (FFP) Usage and Appropriateness in Adult Medical in-Patients: A Retrospective Audit

AbstractAbstract 4375 BACKGROUND:The use of Fresh Frozen Plasma (FFP) has increased considerably in recent years. In the USA there was 70% increase in the use of plasma in 10 years between 1991 and 2001. Around 3.9 million units were transfused in 2001 and 5.7 million units in 2009. FFP is often used inappropriately globally and studies evaluating FFP use in the US are scarce. We conducted a study to assess the trends of FFP use, its implications, appropriateness, and impact of FFP on International Normalized Ratio (INR) in hospitalized adult medical patients with an elevated INR. DESIGN AND METHODS:The study was a retrospective audit of all adult medical in-patients with an INR of 1.2 or higher who received FFP during a 3 month period from December 1, 2011 to February 28, 2012 admitted to Abington Memorial Hospital. A list of all patients who received FFP during the study period was obtained from the blood bank. Patients with major trauma, surgical, post-op, pediatric and obstetric/gynecological patients were excluded. Data was collected on demographics, indications of FFP, pre and post transfusion INR and effect of FFP on pre-transfusion INR. Partial thromboplastin time values (PTT) were not collected. RESULTS:A total of 479 units of FFP were transfused to 97 patients over 114 transfusion episodes. Of the 97 patients, 51 were male (52.6%) and 46 were female (47.3%) with a mean age of 70.4 yrs (median 73 yrs, range 19–95 yrs). Of the total 479 units of FFP, 233 units (48.6%) were given to patients who were not actively bleeding (n=53) with a mean pre-transfusion INR (pre-INR) of 2.82 (range 1.5 to >10, SD 1.6). Warfarin related coagulopathy was noted in 65 patients (67%) and 340 units of FFP (71%) were transfused to these patients. FFP units transfused as pre-procedural prophylaxis were 176 out of 479 (36.7%). Twenty transfusion episodes amounting to 53 units of FFP (11.1%) were given to patients who were not actively bleeding and had a pre-INR of <2. Six patients did not get the planned procedure done and received 25 units (5.2%) of FFP. Of 15 patients who received FFP as pre-procedure prophylaxis with INR <2, only one (6.6%) had normalized post-transfusion INR (post-INR), 5 (33.3%) had post-INR of <1.5 and none had any bleeding complications. Inappropriate use of FFP in this study was noted to be 23.7% (114/479 units of FFP). Mean improvement in INR per unit of FFP for all transfusion episodes (n=114) was 0.36, with mean pre-INR of 3.28 (range 1.5 to >10) and mean post-INR of 1.72 (range 1.2 to 4.2). Mean improvement in INR/FFP in patients with pre-INR <2 vs. those with pre-INR 2 or higher was 0.22 vs. 0.42 respectively (p=0.021). Mean improvement in INR/FFP was significantly higher in patients with warfarin related coagulopathy vs. in those secondary to other causes (0.46 vs. 0.33, p=0.001). Patients who received vitamin K concurrently with FFP had higher mean improvement in INR/FFP than those who did not receive vitamin K (0.45 vs. 0.17, p=0.001). It was also noted that timing of post-INR check was very heterogeneous. Two patients developed an allergic reaction needing stoppage of transfusion and further treatment. Approximately $6,840 were wasted in direct costs ($60 per unit) in just 3 months for only medical in-patients excluding indirect costs (estimated at $100 per unit= $11,400) such as technician, nursing time; transfusion sets, pre-medication, etc. CONCLUSION:Inappropriate use of FFP remains high even among medical in-patients. This study is consistent with previous studies in finding warfarin reversal as the major indication of FFP use and higher the pre-INR, higher was the improvement in INR. Especially, high percentage of use of FFP for pre-procedural prophylaxis with mild elevation of INR is alarming; therefore, studies evaluating restrictive vs. liberal use of FFP are needed.Table 1Mean improvement in INR/FFP in various subsets of patientsVariableMean Improvement in INR/FFP95 % Confidence interval for MeanP valueINR < 20.220.07–0.370.021INR ≥ 20.420.33–0.52Warfarin coagulopathy0.460.35–0.570.001Coagulopathy sec to others0.170.06–0.27FFP + Vitamin K0.450.37–0.560.001FFP Only0.170.09–0.24 [Display omitted] *ICU=Intensive care unit, PCU= Progressive care unit, ER= Emergency room, GMF= General medical floor. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Evaluation of fresh frozen plasma usage at a medical college hospital - A two year study

Aims: The aim of this is study was to evaluate the usage of fresh frozen plasma (FFP) according to indications and to reduce inappropriate usage. Methods: A two year retrospective study was conducted in Medical College Hospital blood bank. Based on the guidelines published by College of American Pathologists, National Health and Medical Research Council and Australasian Society for Blood Transfusion FFP usage were categorized into appropriate and inappropriate. Pre and post-transfusion INR/PT were recorded and the effect of FFP were studied in patients who received FFP. Results: During two years 1884 units of FFP were used for 945 patients. Only 454 (48%) requests were appropriate and 491 (52%) were inappropriate requests. Absence of bleeding or surgical intervention was the commonest reasons for inappropriate FFP use. Mean improvement in the pre-transfusion INR per unit of FFP was 0.75 (median 0.56, range 0–3.7) of which 33% showed significant improvement in the pre-transfusion INR. Conclusions: Our results showed a 48% appropriate and 52% inappropriate use of FFP in patients. Inappropriate FFP use could be reduced by educating the staff, by establishing the hospital transfusion guidelines, by regular evaluation of requistions and by conducting awareness programme among clinicians.

The use of Fresh Frozen Plasma (FFP) in 2007 in France

After a more than four-fold decrease in Fresh Frozen Plasma (FFP) consumption in the nineties in France, probably due to the consequences of HIV epidemics, the use of FFP is again increasing in recent years but at a slower rate. In the surgical and trauma area, recent data suggest that guidelines for the use of FFP may need to be modified. Indeed, contrary to traditional beliefs and guidelines, several studies evaluating conditions with severe hemorrhage (very often associated with coagulation abnormalities) have shown that early use of FFP may be associated with better patient outcome. This has indeed been shown in emergency major vascular surgery and in trauma patients. Although there is a trend to favor a larger use of FFP in specific circumstances (i.e., major hemorrhage), reasons to better control administration of FFP remain. Several audits have indeed shown that the rate of inappropriate FFP transfusion remains high, from 20 to almost 100% of cases. Moreover, FFP continues to be used in patients who may be better treated with other strategies. The best example is the frequently inappropriate use of FFP in bleeding patients with excess anticoagulation from vitamin K antagonists. Even recent studies have shown that prothrombin complex administration is efficient, safe and provides very rapid reversal. Many physicians continue however to administer FFP as a first line treatment with notably increasing the risk of fluid overload, delayed efficacy and increased risk of transfusion-related acute lung injury (TRALI).

Blood component treatment: a retrospective audit in five major London hospitals.

A retrospective audit of 200 transfusion episodes involving the use of platelets or fresh frozen plasma (FFP) was performed in five hospitals in London. It examined the currently used practices of transfusion and assessed the appropriateness of blood component treatment. It was necessary to search for an excess of case notes to provide a sufficient number of patients for review. In 61.5% of cases the reason for using the components was not stated. Inadequate documentation of the use of blood components occurred in 66% of cases. An accepted clinical indication for the use of components was evident in only 36% of the total; inappropriate use of FFP was particularly apparent. It is concluded that many aspects of transfusion practice need to be improved.

Modification of fresh‐frozen plasma transfusion practices through educational intervention

The effect of an educational program designed to address misconceptions about the perioperative transfusion of fresh-frozen plasma (FFP) was examined. Results of a baseline audit of FFP use were compared to those of a study subsequent to the educational process. Statistical analysis of the data revealed that the decrease in the number of patients transfused with FFP, from 32 of 2077 operative cases in Group A (baseline) to 18 of 2540 operative cases in Group B (after education), was significant (p less than 0.01). Analysis of the justifications given for transfusion of FFP revealed that the increase in acceptable indications from 47 percent in Group A to 78 percent in Group B was also significant (p less than 0.05). There was no significant difference between the two groups in units of FFP transfused per patient (Group A, 3.66 +/- 3.2, vs. Group B, 2.47 +/- 1.7) or red cells (Group A, 2.84 +/- 5.2, vs. Group B, 5.22 +/- 4.4), and the patterns of platelet transfusion were similar in the two groups. There was a significant difference in the postoperative partial thromboplastin time (Group A, 38.2 +/- 8.7 vs. Group B, 56.3 +/- 24 seconds, p less than 0.01) but no significant difference in postoperative prothrombin time (Group A, 14.1 +/- 2.6 vs. Group B, 15.4 +/- 3.3 seconds). It can be concluded that an educational program designed to address misconceptions in transfusion practice can alter physician performance and thereby reduce the inappropriate use of FFP.

Inappropriate use of fresh-frozen plasma

Inappropriate use of fresh-frozen plasma

Inappropriate Use of Fresh-Frozen Plasma

Over the past decade hospitals throughout the United States have experienced a dramatic increase in utilization of freshfrozen plasma (FFP). Since this has paralleled a corresponding increase in transfusion of packed red blood cells in relation to whole blood, it may be inferred that much of the FFP is being transfused as a volume expander, rather than as a source of clotting factors or plasma proteins. Use of plasma in this manner not only increases the cost of transfusion, but also increases the risk of transfusion-transmitted disease. Therefore, the recent Consensus Development Conference on this subject, convened by the National Institutes of Health and reported in this issue ofThe Journal,¹was both timely and appropriate. The conference concluded that there was "little scientific evidence to support the increasing use of FFP," especially as a volume expander, as there are safer products that will achieve the same effect. While