Background:
Inappropriate fresh frozen plasma (FFP) prescriptions may account for at least some of the dramatic increase seen in FFP transfusions. In particular, FFP prescribed for bleeding prophylaxis prior to invasive procedures may be largely unwarranted. FFP should only be transfused when indicated, because like any medical therapy, it can cause harm. FFP can lead to fluid overload, febrile and allergic reactions, transfusion‐related acute lung injury, alloimmunization, and infection. The aim of this study was to assess the appropriateness of FFP transfusions at 1 hospital.
Methods:
We reviewed the blood bank records from our 450‐bed public teaching hospital to identify patients older than 18 years who received at least 1 FFP transfusion between January 1, 2008, and December 31, 2009. Among these patients, we randomly selected 500 FFP orders and reviewed the electronic medical records. We adapted recommendations from the College of American Pathologists to classify FFP transfusions as appropriate or not. Appropriate clinical indications were (1) treatment of active bleeding in a coagulopathic patient; (2) bleeding prophylaxis prior to an invasive procedure in a coagulopathic patient; (3) blood transfusion large enough to replace a full blood volume with subsequent evidence of coagulopathy; (4) reversal of warfarin to stop active bleeding or to conduct an emergent, invasive procedure; and (5) plasma exchange for thrombotic thrombocytopenic purpura. Coagulopathy was defined as a prothrombin time or an activated partial thromboplastin time > 1.5 times the midpoint of the normal range. In patients whose coagulation parameters did not meet the criteria for coagulopathy, we used additional laboratory values to classify FFP orders as probably appropriate. These laboratory values included hemoglobin < 8.0 g/dL, platelet count < 50 k/μL, and serum creatinine level > 3.0 mg/dL.
Results:
During the 2‐year study period, 1029 adult inpatients received 1781 orders for FFP, with an average of 5.6 units transfused per order. After random selection of 500 FFP orders, we excluded 54 because of missing laboratory data. Using our definitions of appropriateness, the remaining 464 FFP transfusions were classified as appropriate in 43% (95% CI, 38%–47%), inappropriate in 40% (95% CI, 36%–45%), and possibly appropriate in 17% (95% CI, 13 %–20%). One third of FFP transfusions (149 of 446) were given for bleeding prophylaxis prior to invasive procedures, and 40% of these were inappropriate.
Conclusions:
These early data suggest that 2 of every 5 FFP transfusion orders are inappropriate. Quality improvement initiatives aimed at changing current FFP transfusion practices are warranted.
Disclosures:
L. Verda ‐ none; E. Araujo Mino ‐ none; A. Manchanda ‐ none; S. Dhar ‐ none; S. Gupta ‐ none; N. Yamani ‐ none; A. R. Katz ‐ none; B. P. Lucas ‐ none