Plasma is ineffective in correcting mildly elevated PT-INR in critically ill children: a retrospective observational study

Abstract

BackgroundFresh frozen plasma transfusion is widely utilized in pediatric clinical practice to correct mild coagulopathy. Several studies on adult population have shown that transfusion of plasma cannot effectively correct mild coagulopathy when international normalized ratio (INR) is ≤1.5. Much controversy exists about the generalization of this finding for pediatric populations, especially since pediatric dosages often exceed those in adults. The aim of this study is to determine the prevalence of plasma transfusion with mild coagulopathy (INR ≤ 1.5) and its effectiveness in a pediatric setting.MethodsIn our tertiary referral hospital, we retrospectively reviewed the electronic medical records of all patients who received plasma (April to October 2011) for mildly elevated prothrombin time (PT)-INR levels (≤1.5) and had post-transfusion PT-INR measurements; patients who received intraoperative, ECMO, or plasma exchange-related plasma transfusions were excluded from this study. We abstracted demographic data and pre- and post coagulation test results for the patients included in our study.ResultsAmong 468 plasma transfusions administered to 285 patients from April to June 2011, 60 plasma transfusions (12.8%) were given to patients with PT-INR ≤ 1.5 (range 1.3–1.5). Forty-one patients [median age 2.5 years (IQR, 0.14 to 13.75 years), median weight of 16.0 kg (IQR, 8.0 to 69.3 kg)] who received 41 single plasma transfusions [median dose 11 mL/Kg (IQR, 6–15)] had post-transfusion PT-INR measurements and were included in our study. There was no significant difference in their PT-INR values (p = 0.34) pre- and post-transfusion. Of our study, only 15.4% patients showed post-transfusion normalization [median change in PT-INR 0.15 (IQR, 0.1–0.2)] and were not different from the remaining 85% in age, plasma dose, and bleeding status.ConclusionsThe prevalence of plasma transfusion for correction of mildly elevated PT-INR levels in critically ill children is high (12.8%). Plasma transfusion showed no significant effect in correcting minor prolongation of PT-INR in pediatric patients regardless of age, volume of plasma transfused per kilogram (dosage), or bleeding status.

Prognostic Value of Prothrombin Time in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

“…It has been shown that there was not an association of transfusion with correction of PT/INR or improved survival (38) . Furthermore, studies in both adults and children showed that plasma transfusions to correction for mildly higher PT/INR routinely fail to normalize this value and expose patients to unnecessary risk and delays (39)(40)(41) . The major bleeding rates were similar between the groups in the present study.…”

Preprocedural Coagulation Studies in Pediatric Patients Undergoing Percutaneous Intervention for Appendiceal Abscesses

“…In addition to the potential for infectious transmission associated with transfusion, it is the risk of allergic reaction, acute hemolytic reactions, febrile nonhemolytic transfusion reactions, transfusion related circulatory overload, and transfusion related acute lung injury that are equally life-threatening and far more common. 13,14,24,31 It has been reported that percentages of inappropriate FFP transfusions range from 10 to 83 per cent, 13,31 with the most frequent indication being correction of a prolonged INR in the absence of bleeding. 13,14,16,31 However, published reports on FFP transfusion have reported minimal to no effect when transfusion was used for prophylaxis or as therapeutic agent for bleeding 13 A systematic review of 80 randomized controlled trials investigating the clinical use of FFP concluded no consistent evidence of benefit for prophylactic and therapeutic use across a range of indications.…”

“…13,14,24,31 It has been reported that percentages of inappropriate FFP transfusions range from 10 to 83 per cent, 13,31 with the most frequent indication being correction of a prolonged INR in the absence of bleeding. 13,14,16,31 However, published reports on FFP transfusion have reported minimal to no effect when transfusion was used for prophylaxis or as therapeutic agent for bleeding 13 A systematic review of 80 randomized controlled trials investigating the clinical use of FFP concluded no consistent evidence of benefit for prophylactic and therapeutic use across a range of indications. 33 Although the most common abnormality noted in our study was an elevated PT value (38.9%), it is the INR values that customarily direct treatment with FFP before procedures.…”

Avaliação do impacto institucional da implantação de um programa de Patient Blood Management (PBM), construção de um projeto educacional e revisão da literatura

“…As transfusões de PFC na instituição são frequentemente mal indicadas e ainda assim prescritas em doses muitas vezes insuficientes, reforçando mais um caráter de conforto psicológico para os médicos que uma necessidade estabelecida, dada a baixa capacidade de correção de coagulopatias estabelecidas, mesmo em doses adequadas (SOUNDAR et al, 2014).…”