An Observational Study of the Fresh Frozen Plasma

Pasquier, Pierre; Gayat, Étienne; Rackelboom, T.; Rosa, Julien La; Tashkandi, Abeer; Tesnière, Antoine; Ravinet, Julie; Vincent, Jean‐Louis; Tsatsaris, Vassilis; Ozier, Yves; Goffinet, François; Mignon, Alexandre

doi:10.1213/ane.0b013e31826f084d

Cited by 51 publications

(17 citation statements)

References 23 publications

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“…To date, only one retrospective study has assessed the need for interventional treatment (arterial embolization or hysterectomy) in patients receiving a “low” vs. “high” ratio of plasma:RBC. [73] A lower risk of intervention was reported for women who received a high plasma:RBC ratio (≤ 0.5), however this study involved only a small cohort (n=142) and did not account for the timing of blood product administration.…”

Section: Future Areas Of Investigationmentioning

confidence: 99%

Transfusion and coagulation management in major obstetric hemorrhage

Butwick¹,

Goodnough

2015

Current Opinion in Anaesthesiology

105

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Purpose of Review Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. Recent Findings Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well-resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9% - 2.3%), and investigators have questioned whether a pre-delivery ‘type and screen’ is cost-effective for all obstetric patients. Instead, blood ordering protocols specific to obstetric patients can reduce unnecessary antibody testing. When severe PPH occurs, a massive transfusion protocol (MTP) has attracted interest as a key therapeutic resource by ensuring sustained availability of blood products to the labor and delivery unit. During early postpartum bleeding, recent studies have shown that hypofibrinogenemia is an important predictor for the later development of severe PPH. Point-of-care technologies, such as thromboelastography and rotational thromboelastometry, can identify decreased fibrin-clot quality during PPH, which correlate with low fibrinogen levels. Summary A MTP provides a key resource in the management of severe PPH. However, future studies are needed to assess whether formula driven vs. goal-directed transfusion therapy improves maternal outcomes in women with severe PPH.

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Section: Future Areas Of Investigationmentioning

confidence: 99%

Transfusion and coagulation management in major obstetric hemorrhage

Butwick¹,

Goodnough

2015

Current Opinion in Anaesthesiology

105

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“…Elle est indispensable non seulement pour remplacer la perte sanguine et maintenir l’oxygénation tissulaire, mais aussi pour corriger la coagulopathie de dilution et/ou de consommation qui compliquent fréquemment l’hémorragie obstétricale. Les données récentes de la littérature recommandent un apport précoce et massif des facteurs de la coagulation dans un ratio PFC/CGR compris entre 1/1 et 1/2 [ 3 ]. Ces recommandations ont été essentiellement établis suite aux récentes publications de traumatologie de guerre ou civile suggérant que l’emploi large et précoce de PFC lors des transfusions massives pourraient être associées à une meilleure survie et à une moindre morbidité des patients de traumatologie [ 8 ].…”

Section: Discussionunclassified

“…Les principales étiologies sont l’atonie utérine, la rétention placentaire et le traumatisme du tractus génital. C’est la principale cause de morbi-mortalité maternelle dans le monde [ 3 ]. Sa fréquence est en augmentation aussi bien dans les pays développés tel que le Canada, les Etats unis, l’Australie que dans les pays en voie de développement [ 1 ].…”

Section: Introductionunclassified

“…L’adjonction du fibrinogène (Fbg) et de l’acide tranexamique doit être précoce. L’emploi du facteur VII activé recombinant (rFVIIa) doit rester une solution ultime de prise en charge [ 3 ]. L’objectif de ce travail a été de déterminer le rapport transfusionnel PFC/CGR/CP au cours de notre stratégie de prise en charge des HPP graves dans un centre de maternité hospitalo-universitaire de référence du centre Est de la Tunisie de niveau III.…”

Section: Introductionunclassified

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Stratégie transfusionnelle des hémorragies graves du post-partum: étude rétrospective à propos de 47 cas

Khouadja¹,

Rouissi²,

Mahjoub³

et al. 2016

Pan Afr Med J

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IntroductionL’hémorragie du post-partum est la principale cause de morbi-mortalité maternelle dans le monde. La prise en charge est multidisciplinaire. La stratégie transfusionnelle est capitale jouant un rôle majeur dans le pronostic maternel. L’objectif de ce travail a été de déterminer le rapport PFC/CGR lors de la prise en charge des hémorragies graves du post-partum.MéthodesUne étude Etude rétrospective sur une période de 4 ans (2009-2012) a été réalisée dans un centre de maternité de référence de niveau III du centre-Est tunisien. Elle a inclut les parturientes admises pour une hémorragie sévère du post-partum définit par la nécessité d’une transfusion de plus de 04 CGR durant les 3 premières heures ou de plus de 10 CGR durant les 24 premières heures de prise en charge.RésultatsNotre étude a inclut 47 parturientes. Le diagnostic de l’HPP a été fait devant un saignement vaginal dans 28 cas et suite à une césarienne dans 19 cas. En préopératoire le taux d’Hb a été de 6.3 g/dl. Le rapport transfusionnel (PFC/CGR) a été de 1/0.7.ConclusionAu cours de notre prise en charge, le rapport transfusionnel a été plus élevé que les recommandations récentes de la littérature stipulant une administration précoce et massive de PFC avec un ratio PFC/CGR compris entre 1/2 et 1/1. L’administration du fibrinogène (Fbg) et de l’acide tranexamique doit être précoce. L’emploi du facteur VII activé recombinant (rFVIIa) doit rester une solution ultime de prise en charge.

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“…Although high quality randomised controlled trials have recently been published [ 15 – 17 ], practices such as the routine administration of a 1:1 ratio of RBC to FFP [ 10 , 11 , 18 – 21 ] and greater use of recombinant activated factor VII (rFVIIa) are originally derived from the trauma setting without randomised controlled trial evidence. They have subsequently been extrapolated to non-trauma settings despite important differences in the pathophysiology of CB events in other settings, especially obstetrics [ 22 ]. Currently, there is no process for the systematic evaluation of compliance with the PBM Guidelines.…”

Section: Introductionmentioning

confidence: 99%

Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: the Australian and New Zealand Massive Transfusion Registry study methodology

et al. 2016

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BackgroundThe Australian and New Zealand (ANZ) Massive Transfusion (MT) Registry (MTR) has been established to improve the quality of care of patients with critical bleeding (CB) requiring MT (≥ 5 units red blood cells (RBC) over 4 h). The MTR is providing data to: (1) improve the evidence base for transfusion practice by systematically collecting data on transfusion practice and clinical outcomes; (2) monitor variations in practice and provide an opportunity for benchmarking, and feedback on practice/blood product use; (3) inform blood supply planning, inventory management and development of future clinical trials; and (4) measure and enhance translation of evidence into policy and patient blood management guidelines. The MTR commenced in 2011. At each participating site, all eligible patients aged ≥18 years with CB from any clinical context receiving MT are included using a waived consent model. Patient information and clinical coding, transfusion history, and laboratory test results are extracted for each patient’s hospital admission at the episode level.ResultsThirty-two hospitals have enrolled and 3566 MT patients have been identified across Australia and New Zealand between 2011 and 2015. The majority of CB contexts are surgical, followed by trauma and gastrointestinal haemorrhage. Validation studies have verified that the definition of MT used in the registry correctly identifies 94 % of CB events, and that the median time of transfusion for the majority of fresh products is the ‘product event issue time’ from the hospital blood bank plus 20 min. Data linkage between the MTR and mortality databases in Australia and New Zealand will allow comparisons of risk-adjusted mortality estimates across different bleeding contexts, and between countries. Data extracts will be examined to determine if there are differences in patient outcomes according to transfusion practice. The ratios of blood components (e.g. FFP:RBC) used in different types of critical bleeding will also be investigated.ConclusionsThe MTR is generating data with the potential to have an impact on management and policy decision-making in CB and MT and provide benchmarking and monitoring tools for immediate application.

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An Observational Study of the Fresh Frozen Plasma

Abstract: In this retrospective study, a higher FFP:RBC ratio was associated with a lower requirement for advanced interventional procedures in the setting of postpartum hemorrhage. The benefits of transfusion using a higher FFP:RBC ratio should be confirmed by randomized-controlled trials.

Cited by 51 publications

References 23 publications

Transfusion and coagulation management in major obstetric hemorrhage

Transfusion and coagulation management in major obstetric hemorrhage

Stratégie transfusionnelle des hémorragies graves du post-partum: étude rétrospective à propos de 47 cas

Improving outcomes for hospital patients with critical bleeding requiring massive transfusion: the Australian and New Zealand Massive Transfusion Registry study methodology

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