Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Lieberman, Lani; Lin, Yulia; Cserti‐Gazdewich, Christine; Yi, Qijian; Pendergrast, Jacob; Lau, Wendy; Callum, Jeannie; Collaborative, Safety in Transfusion-Research

doi:10.1002/pbc.26933

Cited by 8 publications

(8 citation statements)

References 32 publications

(40 reference statements)

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“…The strengths of this study include capturing a large number of consecutive plasma transfusion events across multiple institutions, where the data were extracted in a consistent manner across sites with added information regarding timing of transfusions and the date on which procedures were performed. In addition, our findings are concordant with prior plasma audits in adults and children at academic and non‐academic centres [5, 18, 47, 48]. As such, this approach to a digital audit is likely generalizable to other institutions.…”

Section: Discussionsupporting

confidence: 88%

Plasma transfusion practices: A multicentre electronic audit

et al. 2022

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Background and Objectives: Plasma is often transfused to patients with bleeding or requiring invasive procedures and with abnormal tests of coagulation. Chart audits find half of plasma transfusions unnecessary, resulting in avoidable complications and costs. This multicentre electronic audit was conducted to determine the proportion of plasma transfused without an indication and/or at a sub-therapeutic dose.Methods: Data were extracted on adult inpatients in 2017 at five academic sites from the hospital electronic chart, laboratory information systems and the Canadian Institute for Health Information Discharge Abstract Database. Electronic criteria for plasma transfusion outside recommended indications were: (1) international normalized ratio (INR) < 1.5 with no to moderate bleeding; (2) INR ≥ 1.5, with no to mild bleeding and no planned procedures; and (3) no INR before or after plasma infusion. Sub-therapeutic dose was defined as ≤2 units transfused.Results: In 1 year, 2590 patients received 6088 plasma transfusions encompassing 11,490 units of plasma occurred at the five sites. 77.7% of events were either outside indications or under-dosed. Of these, 34.8% of plasma orders had no

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Section: Discussionsupporting

confidence: 88%

Plasma transfusion practices: A multicentre electronic audit

et al. 2022

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“…We read with great interest the study by Lieberman et al. on the utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa in pediatric population with hemostatic impairment . We agree with the authors that there is a tendency for inappropriate use of blood products in pediatric clinical scenarios, which could be of less benefit to the child and may lead to unnecessary transfusion reactions.…”

Section: Rotem Profiles At Different Stages Of Laparoscopic Splenectomymentioning

confidence: 58%

Use of ROTEM in correction of unexpected oozing in a child with a preexisting normal coagulation profile undergoing splenectomy

Sudeep

Hee

2018

Pediatric Blood & Cancer

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“…Furthermore, evidence is emerging that point‐of‐care tests do not accurately reflect fibrinogen concentrations, which may explain some of the conflicting results previously reported 24 . Finally, recent transfusion audits have estimated that up to 24% of cryoprecipitate is transfused inappropriately in relation to current transfusion guidelines 25,26 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Thromboelastography 6s prognostication of fibrinogen supplementation in pediatric cardiac surgery

Lindhardt

Kronborg

Wanscher

et al. 2022

Acta Anaesthesiol Scand

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Background: Implementation of point-of-care tests is recommended to provide tailored substitution during cardiac surgery. The measurement and substitution of fibrinogen have gained particular interest since it is the first coagulation factor to become depleted during cardiac surgery. However, the prognostic ability of thromboelastography (TEG) 6s has not been evaluated in pediatric patients.The aim of the present study was to describe patient characteristics of infants receiving fibrinogen substitution during cardiac surgery and evaluate the prognostic ability of TEG6s after weaning off cardiopulmonary bypass (CPB).Methods: Infants undergoing congenital cardiac surgery with CPB were retrospectively included (n = 279) between January 2017 to July 2019. Patient and perioperative data were collected on the day of surgery until 6:00 AM the next morning.Hemostatic capacity was assessed with TEG6s.The efficacy of TEG-functional fibrinogen-maximal amplitude (TEG-FF-MA) measurements for the prediction of intraoperative bleeding, and thereby cryoprecipitate need, was evaluated by a sensitivity and specificity analysis.Results: Among 174 children with TEG-FF-MA data, 147 (84%) received cryoprecipitate intraoperatively. Cryoprecipitate administration was associated with younger age 66 (10-132) versus 98 (45-204) days (p = .044), higher RACHS-1 classification, and intraoperative bleeding 21 (11-47) versus 5 (3-13) ml/kg (p < .001, mean difference 29 ml/kg [CI: 8-50]). Median TEG-FF-MA values were lower in transfused chil-

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Utilization of frozen plasma, cryoprecipitate, and recombinant factor VIIa for children with hemostatic impairments: An audit of transfusion appropriateness

Cited by 8 publications

References 32 publications

Plasma transfusion practices: A multicentre electronic audit

Plasma transfusion practices: A multicentre electronic audit

Use of ROTEM in correction of unexpected oozing in a child with a preexisting normal coagulation profile undergoing splenectomy

Evaluation of Thromboelastography 6s prognostication of fibrinogen supplementation in pediatric cardiac surgery

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