Cryoprecipitate indications and patterns of use in the pediatric intensive care unit: inappropriate transfusions and lack of standardization

DeSimone, Robert A.; Nellis, Marianne; Goel, Ruchika; Haas, Thorsten; Vasovic, Ljiljana V.; Cushing, Melissa M.

doi:10.1111/trf.13649

Cited by 10 publications

(11 citation statements)

References 14 publications

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“…The number of participants being either "quite confident" or "very confident" before and after access to the app was 10 of 41 (24.4%) and 38 of 41 (92.7%), respectively ( 13,14 platelets, 15 cryoprecipitate). 16,17 Indications for these components are more obscure to the average doctor, and improved guidance is even more essential.…”

Section: Resultsmentioning

confidence: 99%

“…It has previously been demonstrated that simple paper‐based process interventions that require guideline review can improve RBC prescribing, dramatically reduce the total number of units used and increase transfusion appropriateness 2 . The literature contains less information about other blood components, but where reported, studies show equal scope for improvement in adherence to guidelines (FFP, 13,14 platelets, 15 cryoprecipitate) 16,17 . Indications for these components are more obscure to the average doctor, and improved guidance is even more essential.…”

Section: Discussionmentioning

confidence: 99%

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Improving blood‐prescribing decisions: Evaluating the efficacy of a blood guidelines app

Watson

Dhesi

et al. 2020

Transfusion Medicine

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Objectives: To assess the effect of an app providing national blood transfusion guidelines on prescribing decisions. Background: National, regional and local audits in England consistently show inappropriate use of all blood components; around 15%-20% of red blood cells (RBC) and 20%-30% of platelets and fresh frozen plasma (FFP). Hospital transfusion guidelines may be difficult to locate and not agree with national guidelines. We developed and tested a dedicated app providing national evidence-based guidelines for use at the point of care to help clinicians make better decisions when authorising blood. Methods/materials: We identified areas of blood authorisation with high frequency of component use and evidence of widespread unnecessary authorisation. We developed seven representative clinical scenarios where the transfusion of blood components may or may not benefit the adult patient. Responding doctors were invited to select their authorisation choice via an online questionnaire, initially without and then with access to the app. Adherence to guidelines was assessed with and without aid of the app. Results: Using the app, doctors were much more likely to select the correct decision, in accordance with national guidance. Compared with baseline measurements, decisions improved by 67% for RBC, 58% for platelets and 73% for FFP. These improvements were statistically significant. Conclusion: Apps such as "Blood Components" can help doctors do "the right thing rather than the wrong thing". Further studies are required to assess the impact of using the app in clinical practice and the effect on blood component management and financial savings.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Improving blood‐prescribing decisions: Evaluating the efficacy of a blood guidelines app

Watson

Dhesi

et al. 2020

Transfusion Medicine

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“…One study looked at same‐day multicomponent transfusions in paediatric intensive care patients (DeSimone et al, ). The investigators found that the prevalence of co‐transfusions of cryoprecipitate with another blood component ranged from 45·5 to 61·4%, with the most common combination being FP and cryoprecipitate (Table ).…”

Section: Resultsmentioning

confidence: 99%

The epidemiology of multicomponent blood transfusion: a systematic review

Perelman

Khair

Dermer

et al. 2019

Transfusion Medicine

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We performed a systematic review to describe the prevalence of multicomponent blood transfusion and, as a secondary objective, to determine patient characteristics and outcomes associated with multicomponent transfusion. There is a lack of literature on the epidemiology of multicomponent transfusion as most studies concentrate on a single blood product and its utilisation. Patient care and blood management can be optimised by better understanding the patients who receive multicomponent transfusions. The databases Medline, EMBASE and the Cochrane Library of Systematic Reviews were searched. Observational cohort and cross-sectional studies of hospital patients reporting on multicomponent transfusion prevalence or on patient characteristics and outcomes associated with multicomponent transfusion were included. A descriptive synthesis of studies was performed. A total of 37 eligible studies were included. It was found that multicomponent transfusion prevalence varied greatly by patient population and by the combination of blood products given in the multicomponent transfusion. Multicomponent-transfused patients included burn, cardiac surgery, liver surgery and transplant, cancer, infectious diseases, trauma and intensive care unit patients. Five studies found associations between multicomponent transfusion and adverse health outcomes; however, these findings are likely confounded by indication. The overall quality of evidence was low given a fair-to-poor individual study quality, inconsistent multicomponent transfusion prevalence estimates and confounding by indication. Further research is needed to better understand the epidemiology of multicomponent transfusion, including studies on multicomponent transfusion in haematological cancer patients and studies looking for patient characteristics that can better predict multicomponent transfusion need.

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“…Furthermore, evidence is emerging that point‐of‐care tests do not accurately reflect fibrinogen concentrations, which may explain some of the conflicting results previously reported 24 . Finally, recent transfusion audits have estimated that up to 24% of cryoprecipitate is transfused inappropriately in relation to current transfusion guidelines 25,26 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Thromboelastography 6s prognostication of fibrinogen supplementation in pediatric cardiac surgery

Lindhardt

Kronborg

Wanscher

et al. 2022

Acta Anaesthesiol Scand

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Background: Implementation of point-of-care tests is recommended to provide tailored substitution during cardiac surgery. The measurement and substitution of fibrinogen have gained particular interest since it is the first coagulation factor to become depleted during cardiac surgery. However, the prognostic ability of thromboelastography (TEG) 6s has not been evaluated in pediatric patients.The aim of the present study was to describe patient characteristics of infants receiving fibrinogen substitution during cardiac surgery and evaluate the prognostic ability of TEG6s after weaning off cardiopulmonary bypass (CPB).Methods: Infants undergoing congenital cardiac surgery with CPB were retrospectively included (n = 279) between January 2017 to July 2019. Patient and perioperative data were collected on the day of surgery until 6:00 AM the next morning.Hemostatic capacity was assessed with TEG6s.The efficacy of TEG-functional fibrinogen-maximal amplitude (TEG-FF-MA) measurements for the prediction of intraoperative bleeding, and thereby cryoprecipitate need, was evaluated by a sensitivity and specificity analysis.Results: Among 174 children with TEG-FF-MA data, 147 (84%) received cryoprecipitate intraoperatively. Cryoprecipitate administration was associated with younger age 66 (10-132) versus 98 (45-204) days (p = .044), higher RACHS-1 classification, and intraoperative bleeding 21 (11-47) versus 5 (3-13) ml/kg (p < .001, mean difference 29 ml/kg [CI: 8-50]). Median TEG-FF-MA values were lower in transfused chil-

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Cryoprecipitate indications and patterns of use in the pediatric intensive care unit: inappropriate transfusions and lack of standardization

Cited by 10 publications

References 14 publications

Improving blood‐prescribing decisions: Evaluating the efficacy of a blood guidelines app

Improving blood‐prescribing decisions: Evaluating the efficacy of a blood guidelines app

The epidemiology of multicomponent blood transfusion: a systematic review

Evaluation of Thromboelastography 6s prognostication of fibrinogen supplementation in pediatric cardiac surgery

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