Received Fresh Frozen Plasma Transfusion Research Articles

Evaluation of fresh frozen plasma usage at Tezpur Medical College and Hospital: A two-year study

Background: Rational usage of blood components is important to ensure their availability to needy patients and to avoid unnecessary risk. Despite available guidelines, improvement in quality control, and standardization about the use of fresh frozen plasma (FFP), many studies around the world show a high frequency of its inappropriate use. Aims and Objectives: (i) To evaluate the pattern of FFP usage in our hospital and to categorize usage as appropriate or inappropriate based on FFP transfusion guidelines. (ii) To evaluate the effectiveness of FFP transfusion based on pre- and post-transfusion international normalized ratio (INR) values by calculating P-value using a paired t-test. Materials and Methods: This retrospective observational study was done by retrieving requisition forms of all the patients who received FFP transfusion in Tezpur Medical College, Tezpur, Assam, during the period of 2 years (November 01, 2020–October 31, 2022). Patients who received other blood products along with FFP were excluded from this study. Results: 1420 units of FFP were supplied to 850 patients during the study period of which 64% went to males. The most common age group receiving FFP was 30–39 years (28%). The most common indication for FFP was liver disease (33%). Appropriate usage was found in 74% of episodes and inappropriate usage in 26% of episodes. Statistically significant improvement was seen in post-transfusion INR when usage was appropriate (P < 0.001). Conclusion: The study highlighted the pattern of FFP usage in various clinical settings. Regular screening of requisition forms for proper guidelines-based indications, administrative interventions, and meetings of the hospital blood transfusion committee for education and sensitization of medical staff will go a long way in ensuring appropriate usage and good transfusion practice.

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.

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 transfusion in acute variceal haemorrhage: Results from a multicentre cohort study

Fresh frozen plasma (FFP) transfusion is often used in the management of acute variceal haemorrhage (AVH) despite best practice advice suggesting otherwise. We investigated if FFP transfusion affects clinical outcomes in AVH. We performed a retrospective cohort study of 244 consecutive, eligible patients admitted to five tertiary health care centres between 2013 and 2018 with AVH. Multivariable regression analyses were used to study the association of FFP transfusion with mortality at 42days (primary outcome) and failure to control bleeding at 5days and length of stay (secondary outcomes). Patients who received FFP transfusion (n=100) had higher mean Model for End Stage Liver Disease (MELD) score and more severe variceal bleeding than those who did not received FFP transfusion (n=144). Multivariable analysis showed that FFP transfusion was associated with increased odds of mortality at 42days (odds ratio [OR] 9.41, 95% confidence interval [CI] 3.71-23.90). FFP transfusion was also associated with failure to control bleeding at 5days (OR 3.87, 95% CI 1.28-11.70) and length of stay >7days (adjusted OR 1.88, 95% CI 1.03-3.42). The independent association of FFP transfusion with mortality at 42days persisted when the cohort was restricted to high-risk patients and in patients without active bleeding. Fresh frozen plasma transfusion in AVH is independently associated with poor clinical outcomes. As this an observational study, there may be residual bias due to confounding; however, we demonstrate no benefit and potential harm with FFP transfusions in AVH.

Changes in the Use of Fresh-Frozen Plasma Transfusions in Preterm Neonates: A Single Center Experience.

The aim of this study was to evaluate changes in the use of fresh-frozen plasma (FFP) transfusions and the use of clotting tests in preterm neonates in our center over the past two decades. In this retrospective cohort analysis, we included all consecutive neonates with a gestational age at birth between 24 + 0 and 31 + 6 weeks admitted to our neonatal intensive care unit (NICU) between 2004 and 2019. We divided all included neonates into three consecutive time epochs according to date of birth: January 2004 to April 2009, May 2009 to August 2014 and September 2014 to December 2019. The main outcomes were the use of FFP transfusion, coagulation testing and the indications for FFP transfusion. The percentage of preterm neonates receiving FFP transfusion decreased from 5.7% (47/824) to 3.7% (30/901) to 2.0% (17/852) from the first epoch to the last epoch (p < 0.001). Additionally, the rate of neonates undergoing coagulation testing decreased from 24.3% (200/824) to 14.5% (131/901) to 8% (68/852) over the epochs (p < 0.001). Most FFP transfusions were prescribed prophylactically based on prolongation of activated partial thromboplastin time (aPTT) or prothrombin time (PT) (56%). In conclusion, both the use of FFP transfusions and the use of coagulation tests decreased significantly over the years. The majority of the FFP transfusions were administrated prophylactically for abnormal coagulation tests.

Plasma Transfusion Promoted Reprogramming CD4+ T Lymphocytes Immune Response in Severe Sepsis Mice Model Through Modulating the Exosome Protein Galectin 9

Sepsis is a life-threatening disease that results in excessive stimulation of the host’s immune cells. In the animal study, the purpose was to investigate the roles of fresh frozen plasma (FFP) transfusion in shaping the CD4+ T lymphocytes immune response through modulating the secreted exosome protein Galectin-9 in mice with severe sepsis. By using Western blot analysis, we first identified that the protein Galectin-9 is highly accumulated in the blood plasma of severe sepsis mice, and with transmission electron microscopy (TEM) and protein analysis, we found that Galectin-9 is a secreted exosome protein. Thereafter, we treated the severe sepsis mice with the antibiotic Cefuroxime Axetil; one group of mice received FFP transfusion and the other group of mice received normal saline. Surprisingly, the FFP transfusion reduced the secretion of exosome protein Galectin-9 and there was crosstalking between the exosome protein Galectin-9 and CD4+ T lymphocytes in mice with severe sepsis. Results showed that the proliferation of T helper (Th) cells (Th1 and Th17) was promoted, and regulatory T (Treg) cells’ maintenance was inhibited in the sepsis mice after receiving FFP transfusion. Correspondingly, this immune reprogrammed activity shaped the inflammatory cytokine secretion with an increase in the interleukin (IL)-1β, IL-6, and interferon-gamma levels, while it decreased IL-10 levels. Taken together, it was suggested that FFP transfusion promoted reprogramming of CD4+ T lymphocytes’ immune response through inhibiting the secretion of exosome protein Galectin-9 in mice with severe sepsis to relieve immunosuppression.

The Appropriateness of Fresh Frozen Plasma (FFP) Administration in Three Community Teaching Hospitals

Objective: Although Fresh Frozen Plasma (FFP) is indicated in critically ill patients, there are growing concerns about it's cost effectiveness and adverse effects in instances that do not conform to evidence-based indications. Despite a range of adverse reaction with the inappropriate usage of FFP, its usage has significantly increased over the last decade. We previously evaluated the overuse of FFP in our community teaching hospital in 2010-2011 and 2016-2017. The interventions to reduce the inappropriate FFP transfusion were implemented after the results from 2016-2017. The present multicenter study is a post-interventional study that describes practices regarding administration of FFP in three community teaching hospitals between 2017-2018. Methods: A retrospective chart review of patients who received FFP transfusion in three community teaching hospitals between 2017-2018 were included in our study. Criteria were established to evaluate the appropriateness of FFP. Descriptive statistics were utilized to compare the appropriateness of FFP transfusion among the participating hospitals. Results: Overall, 306 participants were evaluated where 25% of the participants (77 out of 306) received inappropriate FFP transfusions. The most common rationale for inappropriate FFP transfusions were bleeding with INR less than 1.5 followed by INR over 1.5 (without any evidence of active bleeding).Based on our study criteria, the proportion of inappropriate FFP transfused out of the total FFP transfused decreased from 49% in the study period 2016-2017 to 25% in the study period 2017-2018. 15% of the study population received inappropriate FFP transfusion for bleeding in 2017-2018 compared to 42% in 2016-2017. Conclusion: Our study showed a reduction in inappropriate FFP transfusions in 2017-2018 compared to 2016-2017. This can be attributed to the interventions implemented after obtaining study results from 2016-2017. The interventions included creating fliers educating about lack of effectiveness of FFP to reduce INR below 1.6 and arranging educational talks from transfusion committee about the evidence-based usage of FFP transfusion. Such interventions are essential to reduce healthcare expenditure and transfusion related adverse events. Disclosures No relevant conflicts of interest to declare.

A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury.

The association between traumatic brain injury (TBI) and coagulopathy is well established. While coagulopathy prophylaxis in TBI involves replenishing coagulation factors with fresh frozen plasma (FFP), its effectiveness is controversial. We investigated the relationship between plasma fibrinogen concentration 3h after initiating FFP transfusion and outcomes and evaluated the correlation with D-dimer levels at admission. We retrospectively examined data from 380 patients with severe isolated TBI with blood samples collected a maximum of 1h following injury. Plasma fibrinogen and D-dimer concentrations were obtained at admission, and plasma fibrinogen concentration was again assessed 3-4h following injury. The patients were divided into two groups based on whether or not they received FFP transfusion. Patients were also divided into subgroups according their fibrinogen level: ≥ 150mg/dL (high-fibrinogen subgroup) or < 150mg/dL (low-fibrinogen subgroup) 3h after injury. Demographic, clinical, radiological and laboratory data were compared between these subgroups. Glasgow Outcome Scale (GOS) scores at discharge and 3months after injury were significantly lower in the FFP transfusion group than in the FFP non-transfusion group. Among patients who received FFP, GOS scores at discharge and 3months after injury were significantly higher in the high-fibrinogen subgroup than in the low-fibrinogen subgroup. Elevated admission D-dimer predicted subsequent fibrinogen decrease. In FFP transfusion, fibrinogen level ≥ 150mg/dL 3h after injury was associated with better outcomes in TBI patients. Assessing the admission D-dimer and tracking the fibrinogen are crucial for optimal coagulopathy prophylaxis in TBI patients.

Rational use of blood components in children with dengue by using WHO and NVBDC guidelines

Background: Dengue fever has become a major public health concern. The disease is now endemic in more than 100 countries with very high case fatality rate and children are the most affected age group worldwide. During explosive outbreaks, there is sudden surge in demands of blood components. Hence the aim of present research was to study the rational use of blood components in children with dengue by using WHO 2012 and NVBDCP 2015 (GOI) guidelines.Methods: Total 219 children of age ˂12 years, who has been diagnosed to have dengue and received blood component therapy during 12 months of study period, were included in the study. The transfusions of blood components [packed red cells (PRC), platelets and fresh frozen plasma (FFP)] were being given to the cases accordance to the WHO and NVBDCP guidelines. The patients’ demographic data, diagnosis, details of blood component therapy used the reason for transfusion was recorded.Results: Out of 219 children, 12(5.4%) children received platelet transfusion, 4(1.8%) children received PRC transfusion and 5(2.2%) children received FFP transfusion. One transfusion (4.7%) out of 12 platelet transfusion was inappropriate and all PRC and FFP transfusions were appropriate according to WHO and National Vector Born Disease Control Programme (GOI) guidelines.Conclusions: The need for platelet transfusion is often overemphasized and the fact is that the platelet count alone is not a predictor of bleeding. Unnecessary and empirical use of platelets should be completely avoided.

The Appropriateness of Fresh Frozen Plasma (FFP) Administration in the Community Teaching Hospital

Objective: Studies demonstrated that inappropriate usage of fresh frozen plasma (FFP) is associated with adverse reaction and poor health outcome in the hospitalized patients. Reducing inappropriate FFP administration in the inpatient settings can minimize potential for adverse events, and foster controllable cost expenditure. Guideline regarding indication of FFP transfusion is scarce. We aimed to assess the appropriateness of FFP transfusion in the setting of community teaching hospital.Methods: A retrospective chart review of patients received FFP transfusion in two community teaching hospitals between 2016-2017 were included in our study. Frequency of appropriateness of FFP transfusion was reported. We also reported percent increase from previous years to compare the FFP usage from 2010-2011 to 2016-2017.Results: Of 138 patients received FFP transfusion in 2016-2017, 62% (86 patients) received inappropriate transfusion. 18% of patients received FFP to correct high INR (>1.6) requiring emergency surgery. 53% of the patients received inappropriate transfusion for bleeding in 2016-2017 compared to 25% in 2010-2011. There was 10% rise of inappropriate or overuse of FFP transfusion in 2016-2017 than 2010-2011.Conclusion: Inappropriate FFP transfusion is significantly associated with adverse health outcome and increased healthcare cost. This study justifies the need for continuous audit for appropriate use of FFP. DisclosuresNo relevant conflicts of interest to declare.

The evaluation of the audit of Fresh-Frozen Plasma (FFP) usage in emergency department

ObjectivesIn our study, the aim is to evaluate the use of Fresh-Frozen Plasma (FFP) in our emergency department and to assess its audit for transfusion. MethodsAll the patients aged 18 and over who received FFP transfusion in the emergency department between March 1, 2013 and March 1, 2016 were included into the study. The audit of FFP use was evaluated by according to ‘British Committee for Standards in Hematology Guideline-2004’. ResultsTotal 141 patients were identified to receive FFP transfusion in our emergency department. When the audit of FFP use was evaluated, 59.6% of all the practices were regarded as improper use. We identified that while the rate of improper use was 40.2% in patients with bleeding, it rose to 90.7% in patients without active bleeding or in those who used FFP with the aim of bleeding prophylaxis. ConclusionWe have determined that FFP transfusions were conducted with improper indications at high rate in our emergency department. Preparing an up-to-date transfusion guideline for the practices in emergency departments in our country and training and supervising the medical staff at regular intervals may help prevent the shortcomings in FFP practices.

Fresh frozen plasma transfusion in critically ill medical patients with coagulopathy*

Although restrictive red cell transfusion practice has become a standard of care in the critically ill, data on the use of fresh frozen plasma (FFP) are limited. We hypothesized that the practice of FFP transfusion in the medical intensive care unit is variable and that liberal use may not be associated with improved outcome. Retrospective cohort study. A 24-bed medical intensive care unit in a tertiary referral center. All patients admitted to a medical intensive care unit during a 5-month period who had abnormal coagulation defined as international normalized ratio (INR) of > or = 1.5-times normal. None. We collected data on demographics, severity of illness as measured by Acute Physiology and Chronic Health Evaluation (APACHE) III scores, INR, bleeding episodes, and transfusion complications. We identified 115 patients with coagulopathy (INR of > or = 1.5) but without active bleeding. A total of 44 patients (38.3%) received FFP transfusion. INR was corrected in 16 of 44 patients (36%) who received transfusion. Median dose of FFP was 17 mL/kg in patients who had INR corrected vs. 10 mL/kg in those who did not (p = .018). There was no difference in age, sex, APACHE III scores, liver disease, Coumadin treatment, or INR level between those who did and did not receive FFP. Invasive procedures (68.2% vs. 40.8%, p = .004) and history of recent gastrointestinal bleeding (41% vs. 7%, p < .001) were more frequent in the group with transfusion. Although there was no difference in new bleeding episodes (6.8% in transfused vs. 2.8% in nontransfused group, p = .369), new onset acute lung injury was more frequent in the transfused group (18% vs. 4%, p = .021). Adjusted for severity of illness, hospital mortality and intensive care unit length of stay among survivors were not different between the two groups. The risk-benefit ratio of FFP transfusion in critically ill medical patients with coagulopathy may not be favorable. Randomized controlled trials evaluating restrictive vs. liberal FFP transfusion strategies are warranted.

Enhancement of neonatal neutrophil motility (chemotaxis) with adult fresh frozen plasma.

We examined the effect of adult fresh frozen plasma (FFP) on neonatal neutrophil (PMN) motility (chemotaxis) using a micropore filter assay. Adult FFP was transfused into 13 neonates receiving FFP transfusion for suspected life-threatening sepsis. Blood was obtained from neonates before and after FFP transfusion for assessment of PMN chemotaxis. An increase in PMN chemotaxis was noted in 12 of the 13 neonates following FFP transfusion, with a mean percentage increase of 12 +/- 3% (p less than 0.01). PMN chemotaxis increased 13 +/- 2% (p less than 0.01) in four bacteremic infants and 11 +/- 5% (p = 0.06) in nine infants without bacteremia. Adult FFP transfusion may enhance impaired neonatal PMN motility and improve outcome from infection in newborn infants.