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

Houben, Nina A M; Heeger, Lisanne E.; Stanworth, Simon; New, Helen; Bom, Johanna G. van der; Fustolo-Gunnink, Suzanne; Lopriore, Enrico

doi:10.3390/jcm9113789

Cited by 11 publications

(10 citation statements)

References 39 publications

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“…There are no recent trials investigating FFP transfusion indications, but based on observational and adult data, most guidelines recommend that FFP should not be administered to non-bleeding infants to correct abnormalities of the coagulation screen alone 15 28–30. Minor coagulation abnormalities are poor predictors of bleeding risk and FFP administration often will not correct these abnormalities 30 31.…”

Section: Discussionmentioning

confidence: 99%

Survey of transfusion practices in preterm infants in Europe

Scrivens

Reibel

Heeger

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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BackgroundPreterm infants commonly receive red blood cell (RBC), platelet and fresh frozen plasma (FFP) transfusions. The aim of this Neonatal Transfusion Network survey was to describe current transfusion practices in Europe and to compare our findings to three recent randomised controlled trials to understand how clinical practice relates to the trial data.MethodsFrom October to December 2020, we performed an online survey among 597 neonatal intensive care units (NICUs) caring for infants with a gestational age (GA) of <32 weeks in 18 European countries.ResultsResponses from 343 NICUs (response rate: 57%) are presented and showed substantial variation in clinical practice. For RBC transfusions, 70% of NICUs transfused at thresholds above the restrictive thresholds tested in the recent trials and 22% below the restrictive thresholds. For platelet transfusions, 57% of NICUs transfused at platelet count thresholds above 25×109/L in non-bleeding infants of GA of <28 weeks, while the 25×109/L threshold was associated with a lower risk of harm in a recent trial. FFP transfusions were administered for coagulopathy without active bleeding in 39% and for hypotension in 25% of NICUs. Transfusion volume, duration and rate varied by factors up to several folds between NICUs.ConclusionsTransfusion thresholds and aspects of administration vary widely across European NICUs. In general, transfusion thresholds used tend to be more liberal compared with data from recent trials supporting the use of more restrictive thresholds. Further research is needed to identify the barriers and enablers to incorporation of recent trial findings into neonatal transfusion practice.

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Section: Discussionmentioning

confidence: 99%

Survey of transfusion practices in preterm infants in Europe

Scrivens

Reibel

Heeger

et al. 2023

Arch Dis Child Fetal Neonatal Ed

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“…Despite the availability of guidelines for neonatal blood products administration, adherence is still low for FFP, which is often administered prophylactically for prolonged PT and aPTT [3,22]. The establishment of age-related reference ranges for standard coagulation tests and the shift from a routine admission coagulation screening to a clinically-oriented approach led to reduced FFP use [15,23].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

et al. 2022

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Fresh frozen plasma (FFP) is largely misused in the neonatal setting. The aim of the study is to evaluate the impact of a Thromboelastography (TEG)-based Quality Improvement (QI) project on perioperative FFP use and neonatal outcomes. Retrospective pre-post implementation study in a level-III NICU including all neonates undergoing major non-cardiac surgery before (01–12/2017) and after (01–12/2019) the intervention. In 2018, the intervention included the following: (1) Training on TEG, (2) Implementation of TEG, and (3) Algorithm for TEG-directed FFP administration in surgical neonates. We compared pre- vs post-intervention patient characteristics, hemostasis, and clinical management. Linear and logistic regression models were used to evaluate the impact of the project on main outcomes. We analyzed 139 neonates (pre-intervention: 72/post-intervention: 67) with a mean (± SD) gestational age (GA) 34.9 (± 5) weeks and birthweight 2265 (± 980) grams which were exposed to 184 surgical procedures (pre-intervention: 91/post-intervention: 93). Baseline characteristics were similar between periods. In 2019, prothrombin time (PT) was longer (14.3 vs 13.2 s; p < 0.05) and fibrinogen was lower (229 vs 265 mg/dl; p < 0.05), if compared to 2017. In 2019, the intraoperative exposure to FFP decreased (31% vs 60%, p < 0.001), while the pre-operative FFP use did not change. The reduction of intraoperative FFP did not impact on mortality and morbidity. Intraoperative FFP use was lower in the post-intervention even after controlling for GA, American Society of Anesthesiologists score, PT, and fibrinogen (Odds ratio: 0.167; 95% CI: 0.070, 0.371). Conclusion: The TEG-based QI project for the management of FFP during neonatal surgery reduced intraoperative FFP exposure. What is Known:• PT and aPTT are poor predictors of bleeding risk in acquired neonatal coagulopathy, leading to likely unnecessary fresh frozen plasma (FFP) transfusion in the Neonatal Intensive Care Setting. • As neonatal hemostasis is a delicate balance between the concomitant reduction of pro- and anti-coagulants drivers, thromboelastography (TEG) is a promising alternative for coagulation monitoring. What is New:• The implementation of TEG, training, and shared protocols contributed to reduced intraoperative FFP use, which was not associated with increased mortality or bleeding events.• These findings inform future research showing that there is clinical equipoise to allow for larger studies to confirm the use of TEG in NICUs and to identify TEG cut-offs for transfusion practice.

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“…[12][13][14] In the neonatal intensive care unit where the patient in this case report was treated, the use of plasma transfusions decreased significantly over the years (analysed between 2004 and 2019). 15 FFP is in the Netherlands a product derived from a single donation of male donors. The FFP product is frozen within 24 h after collection and then stored frozen for a period of at least 6 months after which it can be released if tests for blood transmittable infectious diseases for the donor are negative after the second donation.…”

Section: Discussionmentioning

confidence: 99%

Acute haemolytic transfusion reaction after transfusion of fresh frozen plasma in a neonate—Preventable by using solvent/detergent‐treated pooled plasma?

Henricks

Huisman

Lopriore

et al. 2022

Transfusion Medicine

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Background: Plasma is a commonly used blood product and is available in the form of fresh frozen plasma (FFP) or pooled solvent/detergent-treated plasma. In the Netherlands, solvent/detergent-treated plasma has become the standard product in the adult population since several years, but for neonatal use, FFP remains the product of preference.Description: A preterm neonate developed lung bleeding at day 8 postpartum, for which intubation and mechanical ventilation was required and transfusions with packed red blood cells and plasma, in the form of FFP, were given. Five hours after transfusion, a red discoloration of the urine occurred. An acute haemolytic transfusion was suspected, confirmed by laboratory investigations (fast decrease in haemoglobin, increased free haemoglobin, decreased haptoglobin, increased lactate dehydrogenase and a positive direct antiglobulin test [IgG 2+]). Additional research showed that the FFP product contained nonspecific auto-antibodies that reacted with the transfused erythrocytes, most test erythrocytes and the donor's own erythrocytes. Conclusion:A neonate experienced an acute haemolytic reaction, most probably caused by administrating a FFP product containing auto-antibodies. If transfused with solvent/detergent-treated plasma, such antibodies would have been diluted or captured. This case adds a new argument to the discussion on expanding the use of solvent/detergent-treated plasma to the paediatric population.

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

Cited by 11 publications

References 39 publications

Survey of transfusion practices in preterm infants in Europe

Survey of transfusion practices in preterm infants in Europe

Optimizing fresh-frozen plasma transfusion in surgical neonates through thromboelastography: a quality improvement study

Acute haemolytic transfusion reaction after transfusion of fresh frozen plasma in a neonate—Preventable by using solvent/detergent‐treated pooled plasma?

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