An Audit of Fresh Frozen Plasma Usage in a Tertiary Trauma Care Centre in North India

Abstract

Fresh frozen plasma (FFP) transfusion is a crucial part of management of trauma patients. There is a paucity of literature about the audit of appropriateness of FFP use in trauma patients. To evaluate and analyze the appropriateness of FFP transfusion practices for trauma patients. Prospectively compiled blood bank records of FFP transfusion practices over a period of 4 months from Augusts'08 through Deember'08 were retrospectively analyzed for 207 patients. The number of FFP units used in all these trauma patients were evaluated a propos the cause of injury, departments, type of surgery, presence of coagulopathy, bleeding, massive transfusion, length of hospital stay and patient outcome. Trauma scores such as Glasgow coma score and injury severity score were also calculated to estimate the severity of injury. The appropriateness of FFP transfusion was assessed according to the guidelines drafted by the College of American Pathologists. FFP transfusion for patients experiencing active bleeding, micro vascular bleeding, coagulopathy and/or massive transfusion, was deemed appropriate. Patients receiving FFP were categorized and individually correlated with the outcome. The influences of other variables which affect patient outcome were excluded using stepwise multivariate logistic regression analysis. p value \ 0.05 were considered to be statistically significant. A total of 207 trauma patients were included in the study, 183 (88.4 %) males and 24 (11.6 %) females. The FFP use among neurosurgery patients was 46.9 %, general surgery patients 40.6 % and orthopedics 12.6 %. Appropriate use of FFP was 49.5 % according to the CAP guidelines. Trauma patients who required FFP as a part of treatment were categorized as; Patients who had bleeding alone (n = 40), bleeding with coagulopathy (n = 16), and coagulopathy alone (n = 43), and further correlated with the outcome and were found statistically insignificant. The prevalence of appropriate use of FFP at trauma centre was 49.5 %. The FFP use by neurosurgery:orthopedics:general surgery was 5:1:4. The highest appropriate FFP use was by Neurosurgery department (50.5 %). Assessing the pattern of usage and rate of misuse of FFP units, allows us to establish required strategies to improve the state of affairs.

An Audit of Requests for Fresh Frozen Plasma in a Tertiary Care Center in South India

“…Comparable data have been reported at national and international level [ Table 5]. [1,5,[9][10][11][12][13] Contrary to the belief among many clinicians, FFP transfusions are not risk-free. Allergic reaction, fluid overload, transfusion-related acute lung injury, immune suppression, hemolysis, and infectious complications can all be caused by FFP administration.…”

Analysis of Patterns of Adverse Transfusion Reactions and Management: A Novel Initiative toward Hemovigilance in a Teaching Hospital of South India

“…The association between FNHTR with preceding PRBC transfusion showed significant statistical analysis (p-value < 0.05) concurring with prior studies as well. 7,17 The reason attributed for high adverse events with PRBC association is higher frequency of transfusion compared with other components and majority of cases had prior transfusion leading to antigenic exposure. 18 PRBC being non-leukodepleted component, has higher potential for ATR as evident from our study.…”

Pattern of Utilization of Blood and Blood Products in a Tertiary Care Hospital

“…Hemostatic defect arising because of deficiency of clotting factors can be corrected by transfusing 5-6 units of FFP. 12 Many centers report varying rates of inappropriate transfusion of FFP [13][14][15] and it has been formulated that a sudden reduction in the usage of whole blood would have led to the more inappropriate usage of FFP. 16 A misconception of FFP as a volume expander leads to its use in bleeding cases even without derangement of clotting parameters.…”