Coagulation parameters as a guide for fresh frozen plasma transfusion practice: A tertiary hospital experience

Abstract

Introduction:The appropriate use of blood and blood products means the transfusion of safe blood products only to treat a condition leading to significant morbidity or mortality, which cannot be prevented or managed effectively by other means. The safety and effectiveness of transfusion depend on the appropriate clinical use of blood and blood products. This study was conducted to review the practice of fresh frozen plasma usage (FFP) for transfusion, based on the coagulation profile, requested by various departments in the Hospital Universiti Sains Malaysia (HUSM).Methodology:A retrospective review of blood bank records and coagulation profile results of the patients given FFP from October to December 2006, in Hospital USM was undertaken. The criteria set by the College of American Pathologists in 1994, were used as the guidelines.Results:One thousand six hundred and ninety-eight units of FFP were used during this study period. Only 806 (47.47%) FFP units were deemed appropriate. 20.38% were based on studies without any coagulation tests prior to transfusion and 21.13% were transfused for mild prolongation of coagulation test results. About 6.41% requested FFP in the setting of normal coagulation results. Conclusion:Our results showed that a significant proportion of the FFP transfusion was not guided by the coagulation profile. We recommend that a continuous education on FFP transfusion may help to guide the appropriate request for FFP.

Long-term audit of the use of fresh frozen plasma in a university hospital

“…This likely reflects the high level of awareness and compliance with guidelines among the treating physicians on the potential benefits of utilizing the currently available objective laboratory tests for monitoring FFP therapy. Similar popularity in the use of coagulation tests was also noted in some earlier published audits,8, 11, 12, 18, 42 but was far less popular in others 39 . The disagreements surrounding the use of coagulation testing, when resorting to FFP transfusion, underscores the need for good-quality randomized controlled trials to confirm, or otherwise, the benefit of coagulation tests, particularly the PT and APTT, to support the prophylactic infusion of FFP and also to validate the use of the new global tests of haemostasis, such as thromboelastography and the thrombin generation test, as reliable markers of in vivo coagulation 40, 43, 44…”

False Prolongation of Prothrombin Time in the Presence of a High Blood Concentration of Daptomycin

“…The PT or the PT‐international normalized ratio (PT‐INR) and prothrombin percentage activity (PT‐%) should be monitored in patients who take coumarins or may be coagulopathic due to disseminated intravascular coagulation (DIC) or hepatic dysfunction . DAP may, however, falsely prolong PT.…”

Coagulation test understanding and ordering by medical trainees: Novel teaching approach

“…The excessive ordering of PT/aPTT testing is a particular concern, as the attempt to correct mild elevations of PT/aPTT could result in inappropriate transfusion of frozen plasma (FP) 9,10 . FP is often transfused in patients with mild abnormalities in coagulation tests and corrects these values in only a minority of patients 9,11–14 . A multicenter national audit in the United Kingdom identified that 41.0% of FP transfusions were administered to patients with a mildly prolonged INR and no bleeding 12 .…”

“…9,10 FP is often transfused in patients with mild abnormalities in coagulation tests and corrects these values in only a minority of patients. 9,[11][12][13][14] A multicenter national audit in the United Kingdom identified that 41.0% of FP transfusions were administered to patients with a mildly prolonged INR and no bleeding. 12 A single-center Canadian audit of FP use identified 62.6% of FP transfusions were administered for an INR of 0.9 to 1.8.…”