Clinical use of FFP: results of a retrospective process and outcome audit

Abstract

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.

Fresh frozen plasma transfusion in critically ill patients*

“…In our study, ICU and surgical teams were just as likely to order inappropriate FFP transfusions. Our findings are consistent with previous research (4,5,6,18,19), including some in the critically ill (20,21). Rao and colleagues (20) found that Ͼ20% of critically ill patients are exposed to FFP and that about 40% had high prothrombin time (twice the normal level) as the sole indication for FFP.…”

“…Because our focus was on patients receiving FFP, we did not review bleeding or invasive procedures among patients who did not receive FFP. Although our results are consistent with others (4,5,6,18,19), they represent practices in one ICU and may not be appropriate for generalization. However, our results are likely to be valid.…”

Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials

“…However, clinical practice is characterized by considerable variation in the use of FFP (Sanguis Study Group, 1994). Local audits of FFP use in different hospitals in the UK suggest that only around 60% of transfusions were compliant with recommendations in guidelines and in many cases the doses given were below those recommended (Jones et al , 1998; Eagleton et al , 2000; Stainsby & Burrowes‐King, 2002).…”

A two‐phase audit of fresh frozen plasma: a regional approach

“…In our own region, use of FFP has grown at 2% annually for the past 5 years. In addition, published studies often show unjustifiable use of FFP (Thomson et al ., 1991; Jones et al ., 1998). Concerningly, rates of inappropriate use may be higher in UK than elsewhere (Brien et al ., 1989; Nicholls et al ., 1994; Metz et al ., 1995).…”