An audit has been carried out on the usage of 216 units of fresh frozen plasma (FFP) issued to 41 patients. This involved the systems of FFP issue, the appropriateness of prescription as well as the recorded benefits. Sixty-six per cent of the initial requests for FFP appeared to satisfy criteria for appropriate use. Review of the case notes resulted in some changes to earlier decisions and a slight increase to 73% of those accepted as valid. Only 94% of the FFP issued could be proved to have been given to identified patients and only 88% of case notes showed the reason for treatment. Pre- and post-treatment coagulation results were available for all patients. In 15% of cases, pretreatment results were not significantly abnormal, and consequently no post-treatment improvement found. Coagulation improvement was documented in 78% of cases, and clinical statements on patient progress noted in 40%. In 80% of cases, the patient received other blood products carrying a potential virus risk. Six of the remaining eight patients were treated to stabilize oral anticoagulation. For these patients, virus-inactivated prothrombin concentrates could have been used, resulting in almost the same reduction in virus transmission risk for the group of 41 patients as could be obtained by using virus-inactivated FFP.

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Definition: Leucocyte‐depleted blood components must contain < 5 × 106 leucocytes per unit (red cells) or adult therapeutic dose (platelets). Practical aspects: To achieve residual leucocyte counts of < 5 × 106, leucocyte‐depletion should be carried out under controlled conditions, ideally within 48 h from the collection of the donor unit. The preparation of leucocyte‐depleted blood components should be subject to a quality monitoring programme designed to assure 100% compliance. Indications for leucocyte‐depleted blood components RECOMMENDED Febrile nonhaemolytic transfusion reactions (FNHTRs) 1 To prevent recurrent FNHTRs after red‐cell transfusions, buffy coat‐depleted red‐cell concentrates should be used, if they are available, or alternatively red‐cell concentrates filtered at the bedside. 2 If FNHTRs continue despite these measures, leucocyte‐depleted red‐cell concentrates should be used. 3 To prevent FNHTRs in patients likely to be dependent on long‐term red‐cell support, the use of buffy‐coat‐depleted or bedside filtered red‐cell concentrates should be considered from the outset of transfusion support. 4 The routine use of pooled platelets derived from buffy coats is associated with a low incidence of FNHTRs. The use of platelet concentrates leucocyte‐depleted prior to storage is recommended for patients with reactions despite the use of such components. Bedside filtration of platelet concentrates is not recommended for the prevention of FNHTRs associated with platelet transfusions. Reducing graft rejection after haemopoietic cell transplantation: Patients with severe aplastic anaemia who are potential haemopoietic cell transplant recipients should receive leucocyte‐depleted blood components from the beginning of transfusion support. The same might apply to patients with haemoglobinopathies, but more evidence is required before a definite recommendation can be made. Prevention of transmission of viral infections by blood transfusion: Leucocyte‐depletion of blood components is an effective alternative to the use of CMV‐seronegative blood components for the prevention of transfusion‐transmitted CMV infection to at‐risk patients. Fetal/neonatal transfusions: Leucocyte‐depleted blood components should be used for intrauterine transfusions and for all transfusions to infants below 1 year of age. POSSIBLE Platelet refractoriness: There is currently no convincing evidence that routine leucocyte‐depletion of blood components produces clinical benefits for patients receiving multiple platelet transfusions, although HLA alloimmunization and platelet refractoriness are reduced. Kidney transplants: Pretransplant blood transfusion may confer some benefit to renal transplant recipients, although some patients will become alloimmunized leading to difficulties in the selection of donor kidneys. Consideration should be given to the leucocyte‐depletion of transfusions to renal transplant patients to prevent HLA alloimmunization unless they are part of a deliberate pretransplant immunosuppression protocol. Immunomodulation...

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