FRESH FROZEN PLASMA AND THE PRACTICAL MANAGEMENT: A COMPREHENSIVE AUDIT INCLUDING A SYNOPSIS OF CHALLENGES

ABSTRACT

Background: There is universal concern about the inappropriate use of fresh frozen plasma (FFP). Earlier investigations have indicated that FFP may be associated with high rates of inappropriate transfusion, with some studies indicating rates of up to 50% non-compliance with established guidelines. The current British Committee for Standards in Haematology (BCSH) guidelines on the use of FFP aim to reinforce the message regarding avoidance of its inappropriate use. Aims: Audit the use of appropiate FFP in the context of the COVID pandemia. Methods: Retrospective analysis of requests for plasma transfusion in adults, in our institution, between January/2020 and January/2022, This audit was undertaken to determine current use of FFP and to see if any improvements in the use of this component in relation to recommended guidance. May be we use more FFP due to covid situation. The data was obtained by consulting the Integrated System of Blood Banks. Results: During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. 159 requests for plasma were registered in the analyzed period. In most cases (98), the reason was hemorrhage due to multiple factor deficiencies, including liver disease, trauma, lung disease or a massive transfusion. Prophylactic/therapeutic replacement of congenital factor XI deficiency, associated with bleeding episodes, was indicated in 2 situations. In 1 case, the indication was treatment of HUS and 2 cases of HELLP syndrome. In 7 cases, there was an overlapping of indications. In 7 cases, plasma was administered in unforeseen situations, such as for the correction of laboratory abnormalities without clinical manifestations (4 cases) or for prophylaxis of invasive techniques without abnormal coagulation tests (2 cases). Summary/Conclusion: The proportion of inappropriate requests is similar between surgical and non-surgical specialties and also when broken down into individual departments, the number of inappropriate requests consistently outnumbers appropriate requests across all departments. FFP continues to be frequently used in the absence of bleeding and / or evidence of abnormal coagulation, thus highlights the need for concerted efforts in the education of clinicians who prescribe FFP. In the analysis of the indications for plasma prescription, it is concluded that in 17 % cases the indication was not complete adequately or justifable. 7% of cases given FFP had no record of post-transfusion coagulation data. Following this work, dissemination coupled with education was undertaken. The use of FFP for Warfarin reversal has correctly indicated (> 95%). it may suggest that an education programmes directed at specific aspects of practice do influence clinical behaviour over needs to be addressed.