An audit of fresh frozen plasma usage and effect of fresh frozen plasma on the pre-transfusion international normalized ratio

Abstract

Objective:To audit the usage of fresh frozen plasma (FFP) and to study the effect of FFP on the pre-transfusion international normalized ratio (INR).Materials and Methods:Medical records of 100 consecutive patients who received FFP in our institute were retrospectively studied. FFP usage was classified as appropriate or inappropriate based on the guidelines by the National Health and Medical Research Council and The Australasian Society for Blood Transfusion. Pre-and post-transfusion INR were recorded and the effect of FFP on the pre-transfusion INR was studied in patients who appropriately received FFP. Relationship between the pre-transfusion INR and improvement in the INR per unit of FFP was studied using Pearson’s correlation.Results:Total 325 units were issued for the 100 patients (37 males and 63 females, mean age 33 years, range 1-65 years). Obstetrics and gynecology and medicine departments requested most units of FFP. Total 197 units (60.6%) in 67 patients were appropriately transfused and 128 units (39.4%) in 33 patients were inappropriately used. Mean improvement in the pre-transfusion INR per unit of FFP was 0.79 (median 0.53, range 0-3.5, SD 0.94). A significant improvement in the pre-transfusion INR per unit of FFP was seen in 64.9% patients. A linear relationship was noted between the pre-transfusion INR and improvement in INR per unit of FFP (r=0.89, degree of freedom 55).Conclusion:Proportion of inappropriate FFP usage remains high. A significant improvement in INR is more likely with a high pre-transfusion INR. The improvement in INR per unit of FFP is also more with higher pre-transfusion INR.

Effect of Fresh Frozen Plasma Transfusion on Prothrombin Time in Patients With Mild Coagulation Abnormalities When Compared With Major Coagulation Abnormalities

“…Shinagare et al found 64.9% improvement in the INR per unit of FFP and the improvement in the INR was more in those patients who had a high pretransfusion INR and improvement in the INR was less likely in patients who had a low pretransfusion INR. 17 The above studies support the modification in recent guidelines indicating FFP transfusion as prophylaxis in nonbleeding patients with hereditary coagulation defects prior to invasive procedures. Coagulation activity is determined by ordering coagulation factor levels, such as factor V and factor VII, which are assayed from the PT.…”

An Audit of Requests for Fresh Frozen Plasma in a Tertiary Care Center in South India

“…Evidence shows that the clinical use of blood between different hospitals, different specialties, and different clinical specialists, even within the same group show substantial disparities in the use of various blood components. [1][2][3] Inappropriate use of blood components increases health expenditure, side effects, and risk of transfusion-transmitted infections. The side effects range from allergic reactions, anaphylaxis, transfusion-related acute lung injury, and hemolysis from transfused antibodies to blood group antigens, especially A and B.…”

An Audit of Fresh Frozen Plasma Usage in a Tertiary Trauma Care Centre in North India

“…Neurosurgery department requested the most numbers of FFP units (46.9 %); the highest percentage of inappropriate usage was for orthopedic patients (69.3 %). In a similar retrospective study by Shinagare et al [25]. FFP was most often used in patients of age range 16-30 years, the obstetrics and gynecology department requested the most units of FFP (40 patients, 115 units).…”

“…Two studies have deemed the FFP usage appropriate using guidelines by the National Health and Medical Research Council and The Australasian Society for Blood Transfusion. First reported that 60 % of the patients were appropriately transfused and 40 % were inappropriately transfused [25], and 48 % appropriate and 52 % inappropriate use of FFP in patients was reported by the second in 2012 [29].…”